Typhoid fever is caused by the Salmonella typhi bacterium and is prevalent in developing countries, often linked to poor sanitation. Symptoms include persistent high fever, abdominal distension, and potential complications like bleeding and perforation of ulcers, confirmed by blood and stool cultures. Treatment involves fluid resuscitation, antibiotics, and possibly surgical intervention depending on the perforation's severity and location.

1. Typhoid
Dr. Ashok Jaisingani

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

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

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

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

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

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