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Systematic Review of Surgical Management of Typhoid Intestinal Perforation
Jennifer Rickard*
University of Minnesota, Minneapolis, MN
Background
Typhoid fever is a bacterial infection caused by Salmonella typhi with 21 million cases annually. Intestinal perforation occurs in about 10% of patients with typhoid fever, leading to high morbidity and mortality. Surgical management of typhoid intestinal perforation varies. This study will define the different surgical management options for typhoid perforation as well as the complication and mortality rates.
Methods
A systematic literature review of PubMed, EMBASE and Global Index Medicus databases was conducted using terms related to typhoid and surgery. Studies with less than 10 subjects and those not describing the surgical operations were excluded. Data were abstracted on factors related to surgical interventions, complications and outcomes. Overall postoperative mortality was calculated for all studies.
Results
From 99 published studies in 23 different countries, a total of 10354 patients underwent surgery for typhoid intestinal perforation. 70% of patients were male. A single perforation was identified in 78% of cases (5130/6608). The diagnosis of typhoid perforation was most commonly based on clinical findings. Surgical management options included primary repair (67%), resection and anastomosis (13%) and resection with ostomy creation (6%). Other less common operations included simple drainage, surgical bypass or tube ileostomy. Complication rates ranged from 9-85%. Overall postoperative mortality was 17.9%.
Conclusion
The surgical management options for typhoid fever are varied with the most common technique being primary repair. The complication and mortality rates are relatively high. An understanding of different surgical interventions for typhoid intestinal perforation could help improve management and outcomes.
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