Ileal perforation due to Typhoid fever

Ileal perforation due to Typhoid fever

  Clinical History

• A 29-year-old male patient was admitted with complaints of fever for 2 weeks, abdominal pain and vomiting for 2 days, abdominal distension for 2 days, and not passing stools and flatus for 1 day. 
• He did not receive any treatment during 2 weeks. There was no history of long term abdominal pain and analgesic abuse, but patient was a chronic smoker and alcoholic.
• There was no history of previous similar complaints
• On examination, there was a mild distinction. Guarding and board like rigidity was present.
• Bowel sounds were not heard. PR revealed empty rectum.
• ESR was elevated, WBC count was 15200
• Xray showed air under diaphragm
• Hence a diagnosis of hollow viscous perforation was made.
• Later, widal test was also found to be positive 

Pathogenesis 

Pathogenesis of typhoid intestinal perforations

• Peyer patches become hyperplastic and subsequently ulcerate, with complications of hemorrhage or perforation

Differential Diagnosis 

• Includes appendicitis, appendicular perforation, perforated peptic ulcer, strangulated gut with volvulus, and necrotizing amoebic colitis 

Management 

• Simple closure of the perforation is the treatment of choice and was done in this case.
• With multiple perforations, which occur in about 25% of patients, resection with primary anastomosis or exteriorization of the intestinal loops may be required 

References

• Sabiston Text Book Of Surgery
  
• http://www.meb.uni-bonn.de/dtc/primsurg/docbook/html/x11177.html