Twenty-five years of experience in the surgical treatment of perforation of the ileum caused by Salmonella typhi at the General Hospital of Mexico City, Mexico.

Abstract

This work summarizes the experience obtained during 25 years in the management of intestinal perforations caused by Salmonella typhi with a directed resection and anastomosis at the General Hospital of México City. A total of 352 cases of perforation of the ileum caused by Salmonella typhi seen during the course of 25 years were studied. Patients were divided into two groups; group A had 236 patients and group B had 116 patients. All patients underwent either conventional resection and anastomosis or primary closure (group A) or directed intestinal resection of 10 cm at each side of the perforation on the basis of anatomopathologic studies with serial sections (group B). Morbidity and mortality for group B were each of 1.72%, significantly lower than the 33.47% morbidity and 7.20% mortality in group A. Primary closure should be discouraged, even for a single perforation. Instead directed intestinal resection is recommended as elective surgery for all cases of typhoid fever complicated with intestinal perforation, resecting 10 cm at each side of the distal and proximal perforation.