Prognostic indices of typhoid perforation.

Fifty-eight cases of typhoid perforation are presented. Each case was treated surgically, and the causes of the high post-operative mortality rate are discussed. In this series of patients, the chances of survival after typhoid perforation seem to depend on the following factors: Fever: There is a significantly better prognosis if the perforation occurs in the first week of fever. Period before surgical treatment: The longer the time interval between perforation and surgery, the worse is the prognosis. Serology: Patients giving a negative Widal result and showing a high 'H' antigen titre are more likely to survive. Size of perforation: A patient who has a perforation larger than 10 mm in diameter appears to have a poor chance of survival, but this is not statistically significant. Type of surgery: Resection of the ileum with end to end anastomosis apparently gives the best prognosis, and simple closure of the perforation seems the next best. Drainage of the peritoneum and ileostomy appear mainly ineffective, but these were only carried out in severe cases.