Typhoid Intestinal Perforations: Has the Clinical Importance Decreased in Eastern Anatolia for 36 Years?

OBJECTIVE: Typhoid fever (TF) is an important health problem in developing countries, and typhoid intestinal perforation (TIP) is a serious complication of TF. The present report aims to determine the clinical importance of TIPs for the last 36 years in our region, eastern Anatolia. MATERIALS AND METHODS: The clinical records of 84 surgically treated cases with TIPs were reviewed retrospectively. RESULTS: When the last 36-year period was sectioned by 6-year periods, the distribution of TIPs was found as 39 (46.4% of total), 31 (36.9%), 7 (8.3%), 4 (4.8%), 2 (2.4%) and 1 (1.2%), respectively. The mean age of the patients was 37.1 years (range: 7-68 years), and 66 patients (78.6%) were male. As a surgical procedure, 34 patients (40.5%) had primary repair, 9 (10.7%) had wedge resection with primary repair, 9 (10.7%) had resection with primary anastomosis, 28 (33.3%) had resection with ileostomy, and 4 (4.8%) had exteriorization. Complications were seen in 71 patients (84.5%), while the mortality rate was 10.7% (9 patients). CONCLUSION: Although eastern Anatolia is an endemic region for TF, a certain decrease in the incidence of TIPs was found for the last 36 years. Keeping in mind the TIP, patients with TF may improve the prognosis of this serious disease.

Treatment for ileosigmoid knotting: a single-center experience of 74 patients.

BACKGROUND: Ileosigmoid knotting (ISK) is the wrapping of the ileum around the base of the sigmoid colon. The purpose of this study was to investigate the outcomes for patients undergoing various treatments for ISK. METHODS: The clinical records of 74 ISK patients, over 46.5 years, were reviewed retrospectively. RESULTS: Emergency surgical procedures included resection with primary anastomosis or stoma for patients with gangrenous bowel segments, and detorsion or an additional definitive procedure for patients with viable bowel. Application of these procedures resulted in mortality rates of 0.0% in 14 patients with viable bowel, 12.5% in 8 patients with ileal gangrene, 14.3% in 7 patients with sigmoid colon gangrene, and 28.9% in 45 patients with double-segment gangrene. CONCLUSIONS: The principal strategy in the treatment for ISK is early and effective resuscitation followed by emergency surgery, including untying the knot, excising the gangrenous bowel segment, restoring intestinal continuity by primary anastomosis if possible, and preventing recurrence in selected patients.

Penetrating colon injury: experience of a single centre.

OBJECTIVE: Penetrating colonic injuries are amongst the most discussed intra-abdominal injuries because of the complexity of their management and the severe complications. Penetrating colonic injuries can be managed by either primary repair or diversion. There is a debate over which procedure has to be used under which circumstances. In this retrospective study we analyzed our experience to contribute to the answer. PATIENTS AND METHODS: The records of patients with penetrating colonic injury between January 1995 and December 2006 at the General Surgery Department of Atatürk University School of Medicine, were reviewed retrospectively. RESULTS: One hundred and forty-one patients were included in the study. Ten patients did not need any surgical treatment. Seventy-nine patients (56%) were treated without formation of a stoma and fifty-two patients (36.8%) with formation of a stoma. The overall complication rate was 50.3% (71 patients). The rate of septic complications was 33.3%. CONCLUSION: There is an ongoing debate whether formation of a stoma is indicated in penetrating colonic injury or not. Our clinical experience showed that severe faecal contamination, shock at presentation, and high CIS grades are associated with increased postoperative complications and mortality. Therefore the treatment of penetrating colonic injury in the presence of these risk factors should be stoma formation rather than primary repair.