Outcome of various surgical procedures and their outcome following enteric perforation at Dr. Ruth K.M.Pfau, Civil Hospital, Karachi.

Abstract

Objectives: To observe the outcome of various surgical procedures opted in patients presenting with peritonitis, following typhoid perforation. Study Design: Prospective observational study. Setting: Single surgical unit, Dr. Ruth K.M.Pfau, Civil Hospital, Karachi. Period: 37 months from December 2014 to December 2017. Material and Methods: 25 patients who were admitted from emergency department with the clinical diagnosis of peritonitis following typhoid perforation. The diagnosis of typhoid peritonitis was confirmed on histopathology with the finding of chronic inflammation not associated with granuloma/ giant cell and malignant cells. Results: Out of 25 patients there were 19(76%) male and 6(24%) female patients. The mean age± standard deviation (SD) was 29.52±15 years. Fever and abdominal pain was present in all patient. Generalized peritonitis was present in 23(92%), single perforation at terminal ileum was found in 23(92%). Whereas, loop ileostomy was the commonest procedure performed 14(56%) of patients. En masse abdominal wall closure was performed in 22(88%), however, skin closure was only possible in 11(44%) of the patients. Wound infection was common complication noted 21(84%), whereas 2(8%) patients died during treatment. Conclusion: With reference to morbidities and mortality loop ileostomy seems to be have a good outcome.

East surgical ward enteric perforation score: a new statistically valid scoring criteria for decision between repair or ileostomy in patients with peritonitis due to enteric perforation

“…diversion, resection of disease segment and end to end anastomosis of healthy gut, bypass the perforation as ileotransverse anastomosis and exteriorizing the perforation as loop ileostomy or resection of disease gut and exteriorizing as double barrel ileostomy. 5,6 The decision between repair of enteric perforation and making stoma is always a question of confusion among surgeons. 7 On one hand many surgeons follow the general parameters which favor stoma formation for example huge peritoneal spillage, tachycardia, hypovolemia, oliguria and decreased oxygen saturation, while on other hand surgeons use the personal experience and level of expertise while taking this decision.…”