This presentation is made by Dr Ashok Jaisingani for study purpose, if any one like this than please give comments.

1. Typhoid
Dr. Ashok Jaisingani

2. Introduction
► Typhoid fever is caused by gram –ve organism
salmonella typhi also called as typhoid bacillus.
► Most common in developing countries in tropics
► Poor hygiene and inadequate sanitary condition
attributed to entry of organism into GIT.
► Surgical importance of disease is because of
perforation of typhoid ulcer.

3. Pathology
► Organisms enter into GIT through ingestion of
contaminated foods and water.
► In GIT organism colonize the peyer’s patches of
terminal ileum causing the hyperplasia of lymphoid
follicles followed by necrosis and ulceration
► Microscopic picture show erythrophagocytosis with
histiocytes proliferation
► Ulcer may lead to perforation or bleeding if pt left
untreated or inadequately treated.
► Bowl may perforate several sites including large
bowl also.

4. Clinical Features & Diagnosis
► The patient present in or has recently visited an endemic
areas has persistent high temperature for 2 – 3 weeks.
► The pt may be toxic with abdominal distension from
paralytic ileus.
► Pt may have melena due to hemorrhage from typhoid
ulcer, can lead to hypovolemia
► Positive blood & stool culture confirm the nature of
infection and exclude malaria.
► Widal test also used to detect the presence of agglutinins
to O & H antigens of salmonella typhi
► After second week signs of peritonitis usually denote
perforation confirmed by presence of free gas seen on x-
ray.

5. Other Test To detect specific &
sensitive marker of typhoid fever
► Practical and cheep kits are available for rapid
detection need no special expertise or equipment
are
1- Multi-Test Dip-S-Ticks to detect IgG
2- Tubex to detect IgM
3- TyphiDot to detect IgG & IgM
► These tests are particularly valuable when blood
culture are negative (due to self medication or
pre-hospital treatment with antibiotics).
► These test mostly used when facilities for other
test not available.

6. Treatment
► Resuscitate with IV fluid and antibiotics in
ICU to stabilize patient condition.
► Cephalosporin, metronidazole & gentamicin
are used in combination.
► Despite of potential side effects such as
aplastic anemia of chloramphenical is still
used in developing countries.
► Laprotomy then carried out.

7. Surgery
► Commonest site of perforation is terminal ileum
► Most appropriate surgical option depend upon general condition of the
patients, the site of perforation, number of perforation & degree of
peritoneal soiling.
► Closure of perforation after freshening the edges, wedges resection of
ulcer area and closure,
► Resection of bowl area with or without anastomosis
► Closure of perforation and side-to-side anastomosis
► Iliostomy or colostomy where the perforated bowl is exteriorised after
refashioning the edges
► After closing of ilial perforating area, surgeon should also look for
other sites of perforation or necrotic patches
► Peritoneal lavage is essential, peritoneum should be closed and wound
should be open for delayed primary or secondary intention.