Typhoid Intestinal Perforations: Twenty-six Year Experience S. Selcuk Atamanalp Æ Bulent Aydinli Æ Gurkan Ozturk Æ Durkaya Oren Æ Mahmut Basoglu Æ M. Ilhan Yildirgan Published online: 15 July 2007 Ó Socie ´te ´ Internationale de Chirurgie 2007 Abstract Background Typhoid fever (TF) is a severe febrile illness caused by Salmonella typhi. One of the most lethal com- plications of TF is ileal perforation (TIP). Although the mortality of associated with TIP has decreased slightly over the past decade, it is still high. Methods and Results The records of the 82 surgically treated patients with TIP were evaluated retrospectively. There were 64 men with the mean age of 36.3 years (range: 7–68 years). In surgical treatment, debridement with pri- mary closure was performed in 32 patients (39.0%), and wedge resection with primary closure was performed in 9 (11. 0%), resection with primary anastomosis in 9 (11.0%), and resection with ileostomy in 32 (39.0%). The most common postoperative complication was wound infection, which occurred in 24 patients (29.3%). The overall mor- bidity was highest in the ileostomy group. The overall mortality was 11.0% (9 patients). Age, gender, number, and localization of the perforations (p > 0.05) were not found to affect mortality, but prolonged preoperative per- iod (p < 0.001), extended peritoneal contamination (p < 0.01), and ileostomy procedure (p < 0.001) were found to influence the increase in mortality. Conclusions Early and appropriate surgical intervention with effective preoperative and postoperative care may improve survival in TIP. Typhoid fever (TF) is a severe febrile illness caused pri- marily by the gram-negative bacillus Salmonella enteritidis serovar Typhi [1]. In developing countries, typhoid fever still remains a major health problem because of poor san- itary conditions [2]. According to the best global estimates, there are at least 16 million new cases of typhoid fever around the world [3], and approximately 10,000 patients are hospitalized annually for this infection in Turkey [1]. The most lethal complications of TF are intestinal bleeding and ileal perforations, both arising from necrosis of Peyer’s patches in the terminal ileum [1, 4]. The mortality asso- ciated with typhoid ileal perforations (TIP) ranges between 5% and 80% in various series [4, 5]. Though surgery is accepted as the definitive treatment of TIP, there is no general agreement regarding the choice of procedure [4–6]. Many factors, such as presentation time, adequacy of pre- operative resuscitation, number of perforations and extent of fecal peritonitis, operation time, and technique, have been investigated for their possible effect on prognosis [3– 5], but the effect of the location of ileal perforations is not clear. For the present study we reviewed our patients with TIP to determine the factors that affect mortality and morbidity. Patients and methods The clinical records of 82 patients who underwent surgery because of TIP in the Department of General Surgery, School of Medicine, Ataturk University, in an about 26-year period between June 1978 and December 2004, were re- viewed retrospectively with respect to age, gender, symp- tom duration, perforation number, perforation location, The summary of this paper was accepted as a poster presentation at the 40th Congress of the European Society for Surgical Research, May 25–28, 2005, Konya, Turkey. S. S. Atamanalp (&) Á B. Aydinli Á G. Ozturk Á D. Oren Á M. Basoglu Á M. I. Yildirgan Department of General Surgery, Atatu ¨rk University, School of Medicine, 25070 Erzurum, Turkey e-mail: ssa@atauni.edu.tr; aydinlib@atauni.edu.tr 123 World J Surg (2007) 31:1883–1888 DOI 10.1007/s00268-007-9141-0