Typhoid

This presentation is made by Dr Ashok Jaisingani for study purpose, if any one like this than please give comments.

1. Typhoid Typhoid
Dr. Ashok Jaisingani Dr. Ashok Jaisingani

2. Introduction Introduction
►Typhoid fever is caused by gram –ve organism Typhoid fever is caused by gram –ve organism
salmonella typhi also called as typhoid bacillus. salmonella typhi also called as typhoid bacillus.
►Most common in developing countries in tropics Most common in developing countries in tropics
►Poor hygiene and inadequate sanitary condition Poor hygiene and inadequate sanitary condition
attributed to entry of organism into GIT. attributed to entry of organism into GIT.
►Surgical importance of disease is because of Surgical importance of disease is because of
perforation of typhoid ulcer. perforation of typhoid ulcer.

3. Pathology Pathology
►Organisms enter into GIT through ingestion of Organisms enter into GIT through ingestion of
contaminated foods and water. contaminated foods and water.
►In GIT organism colonize the peyer’s patches of In GIT organism colonize the peyer’s patches of
terminal ileum causing the hyperplasia of lymphoid terminal ileum causing the hyperplasia of lymphoid
follicles followed by necrosis and ulceration follicles followed by necrosis and ulceration
►Microscopic picture show erythrophagocytosis with Microscopic picture show erythrophagocytosis with
histiocytes proliferation histiocytes proliferation
►Ulcer may lead to perforation or bleeding if pt left Ulcer may lead to perforation or bleeding if pt left
untreated or inadequately treated. untreated or inadequately treated.
►Bowl may perforate several sites including large Bowl may perforate several sites including large
bowl also. bowl also.

4. Clinical Features & Diagnosis Clinical Features & Diagnosis
►The patient present in or has recently visited an endemic The patient present in or has recently visited an endemic
areas has persistent high temperature for 2 – 3 weeks.areas has persistent high temperature for 2 – 3 weeks.
►The pt may be toxic with abdominal distension from The pt may be toxic with abdominal distension from
paralytic ileus. paralytic ileus.
►Pt may have melena due to hemorrhage from typhoid Pt may have melena due to hemorrhage from typhoid
ulcer, can lead to hypovolemia ulcer, can lead to hypovolemia
►Positive blood & stool culture confirm the nature of Positive blood & stool culture confirm the nature of
infection and exclude malaria. infection and exclude malaria.
►Widal test also used to detect the presence of agglutinins Widal test also used to detect the presence of agglutinins
to O & H antigens of salmonella typhi to O & H antigens of salmonella typhi
►After second week signs of peritonitis usually denote After second week signs of peritonitis usually denote
perforation confirmed by presence of free gas seen on x-perforation confirmed by presence of free gas seen on x-
ray. ray.

5. Other Test To detect specific & Other Test To detect specific &
sensitive marker of typhoid fever sensitive marker of typhoid fever
►Practical and cheep kits are available for rapid Practical and cheep kits are available for rapid
detection need no special expertise or equipment detection need no special expertise or equipment
are are
1- Multi-Test Dip-S-Ticks to detect IgG 1- Multi-Test Dip-S-Ticks to detect IgG
2- Tubex to detect IgM 2- Tubex to detect IgM
3- TyphiDot to detect IgG & IgM 3- TyphiDot to detect IgG & IgM
►These tests are particularly valuable when blood These tests are particularly valuable when blood
culture are negative (due to self medication or culture are negative (due to self medication or
pre-hospital treatment with antibiotics). pre-hospital treatment with antibiotics).
►These test mostly used when facilities for other These test mostly used when facilities for other
test not available. test not available.

6. Treatment Treatment
►Resuscitate with IV fluid and antibiotics in Resuscitate with IV fluid and antibiotics in
ICU to stabilize patient condition. ICU to stabilize patient condition.
►Cephalosporin, metronidazole & gentamicin Cephalosporin, metronidazole & gentamicin
are used in combination. are used in combination.
►Despite of potential side effects such as Despite of potential side effects such as
aplastic anemia of chloramphenical is still aplastic anemia of chloramphenical is still
used in developing countries. used in developing countries.
►Laprotomy then carried out. Laprotomy then carried out.

7. Surgery Surgery
►Commonest site of perforation is terminal ileum Commonest site of perforation is terminal ileum
►Most appropriate surgical option depend upon general condition of the Most appropriate surgical option depend upon general condition of the
patients, the site of perforation, number of perforation & degree of patients, the site of perforation, number of perforation & degree of
peritoneal soiling. peritoneal soiling.
►Closure of perforation after freshening the edges, wedges resection of Closure of perforation after freshening the edges, wedges resection of
ulcer area and closure,ulcer area and closure,
►Resection of bowl area with or without anastomosis Resection of bowl area with or without anastomosis
►Closure of perforation and side-to-side anastomosis Closure of perforation and side-to-side anastomosis
►Iliostomy or colostomy where the perforated bowl is exteriorised after Iliostomy or colostomy where the perforated bowl is exteriorised after
refashioning the edges refashioning the edges
►After closing of ilial perforating area, surgeon should also look for After closing of ilial perforating area, surgeon should also look for
other sites of perforation or necrotic patches other sites of perforation or necrotic patches
►Peritoneal lavage is essential, peritoneum should be closed and wound Peritoneal lavage is essential, peritoneum should be closed and wound
should be open for delayed primary or secondary intention. should be open for delayed primary or secondary intention.