Background & Objectives: Enteric fever is a major challenge in developing countries and perforation peritonitis is a major cause of morbidity and mortality. The main aim of this study was to compare and evaluate the various operative procedures performed in enteric perforation and to find out the ideal operative procedure (if any) in the treatment of enteric perforation with peritonitis.
Material & Methods: The study was conducted over a period of 3 & 1/2 years (2 years retrospective and 1 & 1/2 years prospective) on 150 patients presentingwith enteric perforation. All patientswere treated as a surgical emergency and given broad-spectrum antibiotic coverage, naso-gastric aspiration, fluid and electrolyte management prior to surgery. Patients were kept on regular follow-up for the next 6 months after treatment.
Results: In our study, 93%of the procedures belonged to one of the two categories i.e. ileostomy or primary closure. Ileo-tranverse bypass and resection-anastomosis were done in 4% and 3% of the patients respectively. The total mortality was 11% & the incidence was more in ileostomy group (17.9%) as compared to the primary closure group (6.7%). The difference in mortality between the ileostomy and primary closure group reached least statistically significant value (p<0.1).
Interpretation and Conclusions: Aggressive resuscitation and early surgery is the key to successful management of enteric perforation. Primary closure should be the treatment of choice in enteric perforation. Ileostomy should be done if there are major risk factors for post-operative fecal fistula formation.
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