Endemic in many developing countries, typhoid fever is a protracted disease that includes bacteremic phase with fever and chills during the first week, widespread reticuloendothelial involvement with rash, abdominal pain and prostration in the second week, ulceration of peyer's patches with intestinal bleeding and perforation during the third week. The infection is caused by bacterium, salmonella typhi. The spread is usually by an oro-fecal route. Contamination of water and edibles are the major source. Infected shellfish can be the source of an outbreak. The incubation period is about 10-15 days. .It is Insidious in onset with fever which rises in a stepladder pattern for 4-5 days , associated with malaise, headache drowsiness and bradycardia .Pulse is often slower than would be expected from the temperature .Complication like perforation of the intestine usually occurs after 10 to14 days of fever.The resulting peritonitis can be rapidly fatal, if not treated promptly and vigorously. It is a challenging surgical emergency in some developing countries. There is a universal consensus that ileal perforations are best treated surgically, contrary to the former belief that they are better managed conservatively. Surgery eliminates the peritoneal soilage and endotoxemia.
After a proper diagnosis is made, perforations are surgically treated depending upon the degree of fecal contamination, general health status of the patient and the number and location of perforations.Surgical techniques are selected on the basis of above factors.Various modalities of surgical options are available, these include primary closure, excision and closure, resection and anastomosis, resection and ileostomy, wedge resection, application of serosal or omental patch, and exteriorization of the perforation.When there is minimum peritoneal contamination with single perforation quite far away from the ileocecal junction and good general health of the patient , the preferred method is primary repair., but in moderate peritoneal contamination with multiple perforations very close to each other, resection anastomosis is usually the choice .Heavily contaminated peritoneal cavity, toxic and moribund patient may require an ileostomy. The mortality and morbidity rate do not depend on surgical techniques, but rather than on the general status of the patient, the virulence of the germs and the duration of the disease before the surgery.Thats why it is very important that the patient gets early initial fluid resuscitation, antibiotic therapy etc for better surgical outcome.
Although there are different methods of cure for typhoid and its complications, it is recommended that every effort be made to prevent the disease in the first place and then to educate the masses to bring the patients to hospital as soon as the symptoms begin. In case where the general condition of the patient is not good, patient has been partially treated and lost many precious hours to seek medical attention, has developed renal shut down, has metabolic and hemodynamic instability, the patients should certainly be managed surgically without delay.