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Aims: The aim was to describe the diagnostic and therapeutic aspects of biliary peritonitis., Patients and Methods: This was a descriptive cross-sectional study with retrospective collection over a period of 10 years including patients operated on for biliary peritonitis., Results: We collected 10 cases of biliary peritonitis with an average age of 38 years with a sex ratio of 2.3. Two patients presented with an abdominal contusion following a road traffic accident. Maximum abdominal pain in the right hypochondrium was present in three patients, signs of peritoneal irritation in all patients, positive Widal and Felix serodiagnosis in eight patients. At midline laparotomy, the gallbladder was perforated in three patients, gangrenous in five, phlegmonous in one, sclero-atrophic in one. Cholecystectomy was performed in all patients. Biliary peritonitis was of traumatic origin in two patients, and typhoid in eight. Postoperatively, there were four cases of sepsis and three cases of parietal suppuration. Three patients died., Conclusion: Biliary peritonitis discovered during laparotomies for peritonitis, was secondary to typhoid cholecystitis, and had a high morbidity and mortality., (Le comité de rédaction se réserve le droit de renvoyer aux auteurs avant toute soumission à l'avis des lecteurs les manuscrits qui ne seraient pas conformes à ces modalités de présentation. En outre il leur conseille de conserver un exemplaire du manuscrit, des figures et des tableaux.)

Introduction: Typhoid perforation is still prevalent in children in developing countries. Hence, the need for a review of the morbidity and mortality from typhoid perforation in children from poor countries., Aim: We review the clinical features, morbidity, and mortality of typhoid perforation in children aged ≤ 5 years in a developing country., Methods: A retrospective 10-year study of children aged ≤ 5 years with typhoid perforation in two tertiary hospitals in northeastern Nigeria. Data regarding clinical presentation, investigations, intra-operative findings, treatment, and outcome were reviewed., Results: Out of 221 children aged ≤ 15 years with typhoid perforation, 45 (20.4%) were aged ≤ 5 years. Fever and abdominal distension were present in all 45 (100.0%), followed by abdominal pain 33 (73.3%), constipation 19 (42.2%), diarrhoea and vomiting 18 (40.0%) and vomiting 13 (28.8%). All patients presented in second week of infection. Plain abdominal radiograph showed pneumoperitoneum suggestive of bowel perforation in 39 (86.7%) patients. Forty-one (91.1%) patients had ileal perforations with various severities of peritonitis. Out of which, 30 (73.2%) were single and 11 (26.8%) were multiple perforations. Two (4.4%) patients had peritonitis without bowel perforation, while 2 (4.4%) others had caecal, gall bladder perforations, respectively. Serious post-operative wound complications occurred in patients with severe peritonitis, multiple perforations, prolonged pre-operative resuscitation, and operation beyond 2 h. Overall, mortality rate was about 26.7% mainly in patients who had multiple perforations, severe peritonitis, prolonged pre-operative resuscitation, and operation time more than 2 h., Conclusion: Multiple perforations, severe peritonitis, and operation time more than 2 h are poor post-operative factors that were associated with poor post-operative outcome in our patients., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Background/aim: In developing countries, enteric perforation due to typhoid continues to have very high morbidity and mortality rates irrespective of the type of operative procedure performed. The aim of the present study was to evaluate the effectiveness of a free omental sheet graft in perforated typhoid enteritis, in comparison to other methods of enteric perforation repair in terms of decreased morbidity, mortality and cost-effectiveness., Method: A non-randomized study of 114 patients with enteric perforations was carried out over a period of 4.5 years. The study was divided in two groups; group I includes 38 cases in which a free omental sheet graft was used in typhoid enteritis with perforation and group II includes 76 cases in which other surgical procedures for enteric perforation repair were used. The outcomes were measured in relation to postoperative complications and mortality., Results: The incidence of complications including faecal fistula was 2.6% in group I (free omental sheet graft group) versus 32.89% in group II. The mortality rate of 2.6% was also lower in group I versus 19.7% in group II., Conclusion: This study concludes that the use of free omental sheet graft on typhoid enteric perforation site is effective in lowering the repair leak rate and thereby decreases the morbidity and mortality associated with these procedures. By lowering the complication rates, it also entails reduction in financial burden.

Splenic abscesses are increasingly being identified, possibly due to widespread use of imaging modalities in clinical practice. The commonest clinical features are high grade fever and exclusively localised left upper quadrant abdominal pain. These symptoms are similar to most infectious diseases prevalent in the tropics, making imaging by ultrasonography or computer tomography a necessity in the diagnosis. There are reports from different geographic areas on splenic abscesses associated with typhoid fever. We reported ruptured splenic abscess presenting with peritonitis as a rare and grave complication of typhoid fever., (Copyright © 2012 Hainan Medical College. Published by Elsevier B.V. All rights reserved.)

Case fatality rate (CFR) for typhoid perforation (TP) has been on gradual but variable decline world wide. This review highlights the progress in management of TP from 1960 including the controversies, current principles of management and the advances associated with the best results of treatment. This is a review of publications on TP from 1960 to 2010 principally from Medline and Ovid databases. Main search terms used are typhoid and perforation. The median CFR by decade was estimated from studies that reported CFR. With advances in surgery and supportive care, median CFR for TP declined from over 50% in 1960 to single digits in the last decade in some countries but with West Africa lagging behind at 16%. Variations in CFR are attributed to differences in perforation-operation interval and quality of care. Opportunities now exist for patients with TP to recover from the disease but priority remains with prevention of enteric fever in endemic areas.

Background/aim: Enteric perforation is a grave complication of typhoid fever. Laparotomy with primary closure is the treatment of choice depending upon the bowel condition. Fecal fistula formation is the main concern in primary closure and the incidence of this complication dramatically decreases when omentum is used as a patch over primary closure., Materials and Methods: A total of 176 patients underwent laparotomy for enteric perforation and they were divided into two groups randomly; Group I--Primary closure with omental patch and Group II--Only primary closure. The outcomes were measured in relation to hospital stay, wound infection, septicemia, fecal fistula, and mortality., Results: The incidence of complications including fecal fistula and mortality is significantly lower in the group I patients. Fecal fistula occurs in 7.7% in group II, while in only 1.1% in group I. The mortality is also lower 3.3% in group II, while 1.1% in group I., Conclusion: Primary closure with omental patch is a better option as compared with only primary closure in enteric perforation patients. It can be recommended as an alternative method to primary closure only in enteric perforation patients.

The increasing awareness of the worse than expected outcome after typhoid ileal perforation (TIP) prompted us to prospectively prognosticate patients with the help of the Jabalpur prognostic score (JPS), a simplified scoring system for peptic perforation peritonitis (PPP). Eighty-two consecutive patients with TIP were studied from May 2005 to August 2008 in the Department of Surgery, NSCB Government Medical College, Jabalpur (MP), India. Six parameters used in the JPS were recorded: age, heart rate, mean blood pressure, serum creatinine, any co-morbid illness and perforation-operation interval. JPS correlated with morbidity and mortality in TIP patients and, as the score increased, so did the morbidity and mortality. Survivors had a significantly lower mean score (3.86 ± 2.23) than non-survivors (7.94 ± 3.6; P < 0.001). Expectedly, TIP patients had worse outcome, stage by stage, than PPP patients. JPS can be easily modified for TIP (JPS-TIP) and can be easily used for its prognostication.

Early surgery in enteric perforation is the only accepted form of treatment in modem day medicine and gives excellent results. Exploratory laparotomy continues to be the mainstay of surgical treatment and several different procedures are recommended in literature. Between January 1998 and November 2001, we have successfully managed 6 consecutive cases of enteric perforation laparoscopically with complete resolution of the disease. There were 4 males and 2 females in our study. The mean time of presentation to us was 38 hours after the perforation (range 22 hours to 63 hours). The mean age was 32 years (range 28 years to 43 years). All patients presented with free air under the diaphragm. A laparoscopic approach was carried out through a 10 mm supraumbilical port and two 5 mm additional ports in the midline infraumbilical area and the left iliac fossa area. Simple one layer closure of the perforation was carried out with 2-0 silk intracorporeally and the peritoneal cavity was washed out and adequately drained. All perforations were localised to the terminal ileum and were single in number. The mean operating time was 54 minutes-(range 42 to 75 minutes). All patients received parenteral ofloxacin and metrogyl. Postoperative recovery was uneventful in all patients and there were no major complications. All patients were discharged from hospital by the 4th postoperative day. Follow up over a period of 12 to 16 months revealed all patients to be in normal health. We strongly recommend a first line laparoscopic approach in all patients with typhoid perforation; as it is a safe and effective method of managing such cases.

The purpose of this retrospective study of a five-year period in western French Guiana is to report our experience in the management of small bowel perforation due to Salmonella typhi and to underline the main diagnostic and therapeutic pitfalls. Even if clinical and laboratory findings were compatible, final diagnosis was reserved until confirmation by postoperative bacteriological findings. In patients without advanced peritonitis, excellent results can be achieved by excision of the edges of the lesion followed by direct suture in cases involving single perforations and by segmental resection followed by end-to-end anastomosis in cases involving multiple perforations. However these techniques cannot be extended to patients presenting severe peritonitis who must be treated by bowel diversion.

Generalised peritonitis is a common and dreaded surgical emergency. Its tropical spectrum continues to be different from its western counterpart. The study represents a retrospective analysis of 250 cases of peritonitis managed surgically over a decade at a large referral surgical unit at New Delhi. Perforations of the upper gastrointestinal tract viz: duodenal ulcer, enteric perforations etc. constitute the majority unlike western series where lower gastrointestinal tract perforations predominate. Despite significant delays in presentation, the overall prognosis remains comparable to the western figures. A comparatively younger age group involved may be responsible for better outcome.

Peritonitis due to typhus is still frequent in Vietnam. We studied retrospectively 83 cases of 83 patients operated for peritoneal perforations due to typhus between January 1986 and December 1987. There were more males than females (56 versus 27) and most of the patients were under 30 years of age (72.2%). The diagnosis was made on the basis of clinical picture of fever associated with peritonitis and ileal lesions seen at laparotomy. Treatment for most patients included surgical exeresis, suture of the perforation and lavage and draining of the abdominal cavity. Fifteen patients died during the perioperative period (18% operative mortality). There were 76 cases of post-operative complications involving 55 patients. The most frequent complication was parietal infection observed in 55 cases (66.3%). The most severe complication was suture failure seen in 5 cases, 4 of which had a fatal outcome. Operative delay was a statistically significant factor of prognosis. In the specific situation of our clinical experience, simple suture or suture excision remain the most adapted and effective modes of treatment.

An overview of a series of patients treated for peritonitis over the last 5 years showed that in 64 cases (6.8%) the infection was due to a non traumatic perforation of small intestine. The predominant aetiology was typhoid fever (39 cases), other causes for the peritonitis were perforation of an abdominal diastasis (10 cases) or a Meckel's diverticulum (8 cases), and perforation due to an acute ileitis (2 cases), a non Hodgkins malignant lymphoma (2 cases), a necrotizing enteritis (2 cases) and a jejunal tuberculoma (1 case). The surgical attitude to be adopted for repair of the perforated loop is dependent on the aetiology and the degree of peritoneal sepsis. Enterostomy should be performed as a safety measure in patients with perforation due to typhoid fever.

Generalized peritonitis is a common surgical emergency in India, the 'Tropical Spectrum' of generalized peritonitis being different from the western spectrum. A total 155 cases of generalized peritonitis were surgically treated at the All India Institute of Medical Sciences between 1981 and 1987, all patients undergoing peritoneal toilet with drainage after the cause of their peritonitis had been treated. The most common cause of peritonitis was peptic ulcer perforation, with simple closure being associated with a 2 per cent mortality, while typhoid perforation was the second most common cause. The diagnosis was clinical, supported by the operative findings of a terminal ileal perforation while bacteriological, serological and histopathological confirmation was retrospective. Appendicular perforations were less common than in the west but the clinical picture was the same. Tubercular perforations were not uncommon with a previous history of subacute intestinal obstruction and evidence of tuberculosis on chest X-ray suggesting the diagnosis. Ruptured amebic liver abscess was the most common hepatobiliary cause of generalized peritonitis with drainage of the abscess producing good results. The average hospital stay was 15 days with an overall mortality of 8 per cent.

Of the 257 typhoid enteric perforations analysed at the Departments of General and Paediatric Surgery, Ankara University Hospital, through the years 1979-1986, 74.9% were males, while the patients mean age was 35.8 years. The early signs and symptoms averaged 5.9 days. The corresponding percentages for the occurrence of abdominal pain, fever, nausea and vomiting and central nervous system disorders which constituted the clinical findings were 97.27, 51, 61.2 and 18 respectively. While the mean value for the white blood count ranged around 6600, only 61.9% of the cases had diagnostic findings in their erect abdominal roentgenograms. The standard method for the treatment of typhoid enteric perforations is still presently primary suturing of the perforated viscus and peritoneal drainage. Despite the use and misuse of a large variety of antibiotics, typhoid perforations still have a high morbidity of 74.1% and a mortality of 31.4%. Generalized peritonitis (78.4%), is considered to be to the most important cause in both situations.

The clinical picture of typhoid peritonitis in 67 patients is described. All the patients were operated upon. General roentgenography of the abdominal cavity and Widal's reaction are thought to be an important help in diagnostics of typhoid peritonitis. An analysis of postoperative complications and lethality in this group of patients is presented.

Under observation were 17 patients with typhoid peritonitis. The authors describe some specific features of the clinical course of this complication. The necessary method of treatment is thought to be an urgent operation with suturing the perforated ulcer and peritonization of all the ulcers found or a resection of the injured portion of the intestine, peritoneal dialysis, drainage of the thoracic lymph duct and intensive transfusion therapy in the postoperative period. Eleven patients recovered, six patients died.

Diffuse peritonitis secondary to ileal perforation due to typhoid fever are serious and frequent in our country. 42 cases are reported. In 85% the perforation is on the end of the ileum between 10 to 50 cm from the Bauhin's valve. In 32 cases there is only one perforation. 8 patients underwent 50 cm resection of the end of the ileum with terminal ileostomy: one died. One case underwent closure. The washing out of peritoneum is done in 15 cases. The covery of the continuity is usually executed 3 months later by an iliac surgical approach in preference.

At our clinic 185 patients with severe typhoid fever were treated. In 51 cases severe complications required a surgical therapy: 24 times bleeding of small or large intestine, 14 times perforation of the bowel and 13 times acute typhoid cholecystitis. Lethality of typhoid peritonitis with perforation is nowadays--inspite of specific therapy with antibiotics--still between 40% and 50%; lethality at our clinic was 37.5%. Dangerous complications are bleeding and re-perforation, which require an aggressive surgical procedure.