Review of Paediatric Typhoid Perforation Cases Managed at a Tertiary Care Centre

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Digamber Chaubey
Sandip Kumar Rahul
Ramdhani Yadav
Vijayendra Kumar
Nitesh .
Rupesh Keshri


Background: Any criteria (clinical, pathologic, microbiological or histo-pathologic) attributing a case of Paediatric gastrointestinal perforation to Typhoid would be of help in reaching a proper diagnosis to guide appropriate management.

Aims and Objectives: To review all cases of Typhoid perforation for their clinical, pathologic and intra-operative findings.

Materials and Methods: A retrospective study was conducted on all cases of typhoid perforation (gastrointestinal perforation with positive Widal test) operated at a tertiary care centre from September 2015 to September 2018. Data regarding their clinical findings, investigation results, intraoperative findings, nature of the surgical intervention, postoperative results and histopathological findings were collected from their records and analysed.

Results: A total of 13 patients were operated during this period with positive Widal’s test at presentation. 6/13 had single ileal perforation; two patients had multiple ileal perforations; perforation at atypical sites were found in four patients (one each at gastric, duodenal, caecal and rectal); one patient presented with Meckel’s band obstruction with multiple ulcers – this patient was sick and died despite a diverting ileostomy in the postoperative period. While 8/13 patients had primary closure of the perforation site, diversion through ileostomy was performed in five patients. All patients did well in the post-operative period except one patient of multiple ulcers and obstructing Meckel’s band who died in the post-operative period.

Conclusion:  On encountering a gastrointestinal perforation, no definite symptomatology or its pattern, no clinical examination findings, no intraoperative characteristics of the perforation and no biopsy can definitively point towards Typhoid as the cause. Therefore, we still have to depend on serological tests in correlation with clinical features to reach a conclusive diagnosis. Cultures and PCR, although sensitive are either time-taking or expensive to guide management. Typhoid perforation can have vivid and atypical presentation depending on the number and site of perforation.

Culture, perforation, serological test, typhoid, widal.

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How to Cite
Chaubey, D., Kumar Rahul, S., Yadav, R., Kumar, V., ., N., & Keshri, R. (2020). Review of Paediatric Typhoid Perforation Cases Managed at a Tertiary Care Centre. Journal of Advances in Medicine and Medical Research, 32(1), 1-8.
Original Research Article


Upadhyay R, Nadka MY, Muruganathan A, Tiwaskar M, Amarapurkar D, Banka NH, Mehta KK, Sathyaprakash BS. API recommendations for the management of typhoid fever. J Assoc Physicians India. 2015;63:77-96.

Arora P, Thorlund K, Brenner DR, Andrews JR. Comparative accuracy of typhoid diagnostic tools: A Bayesian latent-class network analysis. PLoS Negl Trop Dis. 2019;13(5):e0007303.
DOI: 10.1371/journal.pntd.0007303.

Tran Vu Thieu N, Trinh Van T, Tran Tuan A, Klemm EJ, Nguyen Ngoc Minh, Voong Vinh P, et al. An evaluation of purified salmonella typhi protein antigens for the serological diagnosis of acute typhoid fever. Journal of Infection. 2017;75:104-14.

Bhutta ZA. Current concepts in the diagnosis and treatment of typhoid fever. BMJ. 2006;333(7558):78-82.

Wijedoru L, Mallett S, Parry CM. Rapid diagnostic tests for typhoid and paratyphoid (enteric) fever. Cochrane Database Syst Rev. 2017;5: CD008892. DOI:10.1002/14651858.CD008892.pub2

World Health Organization. Typhoid and other invasive Salmonellosis. Vaccine-Preventable Diseases Surveillance Standards; 2019.

Neil KP, Sodha SV, Lukwago L, O-Tipo S, Mikoleit M, Simington SD, et al. A large outbreak of typhoid fever associated with a high rate of intestinal perforation in Kasese District, Uganda, 2008–2009. Clin Infect Dis. 2012;54:1091–9.

Saha SK, Ruhulamin M, Hanif M, Islam M, Khan WA. Interpretation of the Widal test in the diagnosis of typhoid fever in Bangladeshi children. Ann Trop Paediatr. 1996;16:75-8.

National Institute for Communicable Diseases. Typhoid: NICD Guidelines for Diagnosis, Management and Public Health Response; 2016.

Parry CM, Hien TT, Dougan G, White NJ, Farrar JJ. Typhoid fever. N Engl J Med. 2002;347:1770-82.

Atamanalp SS, Aydinli B, Ozturk G, Oren D, Basoglu M, Yildirgan MI. Typhoid intestinal perforations: Twenty-six year experience. World J Surg. 2007;31:1883–8.

Sharma A, Sharma R, Sharma S, Sharma A, Soni D. Typhoid intestinal perforation: 24 perforations in one patient. Ann Med Health Sci Res. 2013;3(Suppl 1):S41-3.
DOI: 10.4103/2141-9248.121220

Contini S. Typhoid intestinal perforation in developing countries: Still unavoidable deaths? World J Gastroenterol. 2017; 23:1925-1931.
DOI: 10.3748/wjg.v23.i11.1925

Chalya PL, Mabula JB, Koy M, et al. Typhoid intestinal perforations at a University teaching hospital in Northwestern Tanzania: A surgical experience of 104 cases in a resource-limited setting. World J Emerg Surg. 2012;7:4.

Pandey A, Gangopadhyay AN, Upadhyaya VD. Typhoid sigmoid colon perforation in an 18-month-old boy. World J Pediatr. 2008;4:305-7.

Chaubey D, Verma AK, Pandey A, Gupta A. Isolated rectal perforation presenting as peritonitis in a child with enteric fever. J Child Sci. 2017;7:e120–e122.

Ekenze SO, Okoro PE, Amah CC, Ezike HA, Ikefuna AN: Typhoid ileal perforation: Analysis of morbidity and mortality in 89 children. Niger J Clin Pract. 2008;11:58-62.

Kella N, Radhi PK, Shaikh AR, Leghari F, Qureshi MA. Factors affecting the surgical outcome in typhoid intestinal perforation in children. Paed Surg. 2010;16:567-70.

Beniwal US, Jindal D, Sharma J, Jain S, Shyman G. Comparative study of operative procedures in typhoid perforation. Indian J Surg. 2003;65:172-7.

Nguyen QC, Everest P, Tran TK, House D, Murch S, Parry C, Connerton P, Phan VB, To SD, Mastroeni P, White NJ, Tran TH, Vo VH, Dougan G, Farrar JJ, Wain J. A clinical, microbiological, and pathological study of intestinal perforation associated with typhoid fever. Clin Infect Dis. 2004; 39:61-7.