THE PROGNOSTIC FACTORS IN TYPHOID ILEAL PERFORATION - A PROSPECTIVE-STUDY OF 50 PATIENTS

To determine the prognostic factors in typhoid ileal perforation, a pr ospective study was carried out in 50 patients with typhoid ileal perf oration confirmed at operation. Attention was paid to pre-operative an d post-operative factors. The sex ratio was 4: 1 in favour of male, wi th an age range of 7-42 years and a mean of 19.5 years. The age and se x had no effect on the prognosis. Late presentation, delay in operatio n, multiple perforations, and drainage of copious quantities of pus an d faecal material from the peritoneal cavity adversely affected the in cidence of faecal fistula and the mortality rate. The development of f aecal fistula significantly affected the mortality rate. Early present ation, single perforation and moderate amounts of pus/faecal matter dr aining from the peritoneal cavity enhanced the development of wound in fection, wound dehiscence and residual intra-abdominal abscess. Fourte en patients (28%) died, 50% of these within the first 5 post-operative days. Seventy-one per cent of the 14 died within 10 days. Thus, survi ving for more than 10 post-operative days tends to give a better chanc e of recovery. In conclusion, this study has attempted to outline thos e factors with a strong effect on the progression and outcome of typho id ileal perforation in Nigerian patients.