Typhus perforation in the tropics. Apropos of 83 cases

Peritonitis due to typhus is still frequent in Vietnam. We studied retrospectively 83 cases of 83 patients operated for peritoneal perforations due to typhus between January 1986 and December 1987. There were more males than females (56 versus 27) and most of the patients were under 30 years of age (72.2%). The diagnosis was made on the basis of clinical picture of fever associated with peritonitis and ileal lesions seen at laparotomy. Treatment for most patients included surgical exeresis, suture of the perforation and lavage and draining of the abdominal cavity. Fifteen patients died during the perioperative period (18% operative mortality). There were 76 cases of post-operative complications involving 55 patients. The most frequent complication was parietal infection observed in 55 cases (66.3%). The most severe complication was suture failure seen in 5 cases, 4 of which had a fatal outcome. Operative delay was a statistically significant factor of prognosis. In the specific situation of our clinical experience, simple suture or suture excision remain the most adapted and effective modes of treatment.