Suggested Books To Read During Your General Surgery Residency (Read More)
Bailey & Love's Surgery, 27th Edition Surgery Essence by Pritesh Singh (PGMEE) Sabiston's Textbook of Surgery
Farquharson's Textbook of Operative General Surgery, 10th Edition Surgery Sixer for NBE by Rajamahendran Surgery PreTest Self-Assessment and Review, Thirteenth Edition
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Ileal perforation due to Typhoid fever

Ileal perforation due to Typhoid fever
Ileal perforation due to Typhoid fever
  Clinical History
  • A 29-year-old male patient was admitted with complaints of fever for 2 weeks, abdominal pain and vomiting for 2 days, abdominal distension for 2 days, and not passing stools and flatus for 1 day. 
  • He did not receive any treatment during 2 weeks. There was no history of long term abdominal pain and analgesic abuse, but patient was a chronic smoker and alcoholic.
  • There was no history of previous similar complaints
  • On examination, there was a mild distinction. Guarding and board like rigidity was present.
  • Bowel sounds were not heard. PR revealed empty rectum.
  • ESR was elevated, WBC count was 15200
  • Xray showed air under diaphragm
  • Hence a diagnosis of hollow viscous perforation was made.
  • Later, widal test was also found to be positive 
Pathogenesis 

Pathogenesis of typhoid intestinal perforations
Pathogenesis of typhoid intestinal perforations
  • Peyer patches become hyperplastic and subsequently ulcerate, with complications of hemorrhage or perforation
Differential Diagnosis 
  • Includes appendicitis, appendicular perforation, perforated peptic ulcer, strangulated gut with volvulus, and necrotizing amoebic colitis 
Management 
  • Simple closure of the perforation is the treatment of choice and was done in this case.
  • With multiple perforations, which occur in about 25% of patients, resection with primary anastomosis or exteriorization of the intestinal loops may be required 
References




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