Risk factors affecting morbidity in typhoid enteric perforation.

INTRODUCTION: Typhoid enteric perforation is a cause of high morbidity and mortality. This study aim is to determine the factors affecting morbidity in patients with typhoid enteric perforation.

MATERIALS AND METHODS: Ninety-six patients with typhoid enteric perforation were reviewed. The variables are defined as follows: Age, gender, complaints, perforation-operation interval, typhoid fever treatment before the perforation or not, white blood cell (WBC) count, hemoglobin level (Hgb), intraoperative peritonitis intensity, the number of perforations, and type of surgery were examined. To determine the independent risk factors that might affect morbidity in typhoid enteric perforation, we made use of multivariate logistic regression analysis.

RESULTS: Nine variables were applied the univariate analysis, which were greater than 30 years (P = 0.218), male gender (P = 0.02), preoperative treatment (P = 0.147), less than or equal to 48 h perforation-operation interval (P = 0.013), greater than 4,000 K/UL WBC (P = 0.388), less than 8 g/dL Hgb (P = 0.026), greater than 29 Mannheim Peritonitis Index (P < 0.0001), multiple perforation number (P = 0.614), and primary repair (P = 0.105). Logistic regression analysis showed that Mannheim Peritonitis Index (P = 0.014) and perforation-operation interval (P = 0.047) were defined as independent risk factors affecting morbidity.

CONCLUSIONS: If liquid electrolyte, blood, antibiotics, and parenteral nutrition are applied in typhoid enteric perforation cases adequately, then severe peritonitis becomes an independent risk factor that affects morbidity. Early diagnosis and appropriate surgery type would decrease morbidity and mortality.