Typhoid perforation: factors affecting mortality and morbidity.

Thirty-six patients were operated upon for terminal ileal perforations in a two-year period; four cases were due to trauma, four to ascariasis and 28 to typhoid. Ileal perforations due to ascaris worms are differentiated from typhoid ileal perforations because worms are usually found lying freely in the peritoneal cavity or in close association with the perforations. Also, tests for Salmonellae and Shigella are usually negative. Factors affecting mortality and morbidity in typhoid ileal perforation include the age of the patient, duration of perforation before surgery, presence of additional complications, such as massive rectal bleeding, the extent of the surgery, and the number of perforations present. Chloramphenicol in massive doses is indicated for all these patients. Our experience suggests that the hematoxicity of this drug has been over-rated. Postoperative complications are: wound infection (about 95% of cases), malarial fever, septicemia, fecal fistula, intraabdominal abscess, pulmonary infection, jaundice and transient psychosis.