Typhoid Intestinal Perforation: A Management Perspective

Abstract

Despite substantial advances in global scientific study, typhoid fever and its repercussions remain a major public health concern, particularly in underdeveloped nations. The mode of transmission for this pathogen is commonly through the faecal-oral route, and it frequently exhibits endemic characteristics. This chapter aims to find out which operative procedure (either single-layer or double-layer closure) should be planned in enteric perforation by comparing these, in terms of morbidity, mortality and cost-effectiveness.  The present investigation was conducted on 50 patients of either sex in the Department of General Surgery JLN Medical College, Ajmer, Rajasthan, India. They were split into two groups:  Group --A (conventional double-layer repair in 25 patients) and Group -B (single-layer interrupted sutures in 25 patients). Based on the findings of this study, it is possible to conclude that single-layer repair for enteric perforation can be constructed in less time and with fewer complications than the conventional two-layer repair technique; it also recovers the patient earlier and causes earlier bowel activity than two-layer repair.  The findings favoured the single-layer group since the time required for perforation repair and overall surgical time was shorter in this group. Furthermore, single-layer repair aids in early bowel activity and healing for the patient more than the double-layer approach. There is no clear benefit to double-layer closure of an enteric perforation over single-layer repair in terms of the development of faecal fistulas, length of surgery, resumption of bowel movements, and other complications such as wound abscess formation, wound dehiscence, respiratory problems, etc. Single-layer repair is the treatment of choice for most surgeons due to its shorter operating time and other benefits.