Typhoid enteric perforation.

Of 306 cases of typhoid enteric perforation, 267 were reviewed retrospectively to determine prognostic indices and therapeutic options influencing outcome. The morbidity and mortality rates were 55.4 and 28.5 percent respectively, and the median duration of hospitalization was 18 days. On the basis of these findings, a prospective series of 39 patients was studied. In the preoperative period, aggressive resuscitation and antibiotic therapy with a combination of chloramphenicol, ampicillin/sulbactam and ornidazole were administered. All patients were given total parenteral nutrition to provide adequate metabolic support in the postoperative period. The morbidity and mortality rates decreased to 25 and 10 percent respectively, and the median hospitalization time was 12 days. The results of this study suggest that aggressive resuscitation and a combined antibiotic regimen in the preoperative period, selected operative procedure and metabolic support decrease the morbidity and mortality of typhoid enteric perforation.