Background: Ileal perforation is a common problem seen in tropical countries; the commonest cause being typhoid fever. The aim of this study is to assess clinical presentation, investigations, diagnosis, the management and postoperative complications of typhoid ileal perforation. The study also aims to assess the outcomes in these patients and the factors affecting prognosis.

Methods and Material: This prospective study was conducted by selection of consecutive 50 cases presenting with symptoms and signs suggestive of typhoid ileal perforation. The data in the study was collected by the use of a pretested proforma to collect relevant information from individual patient after the inclusion and exclusion criteria applied by a meticulous clinical examination, relevant investigations and appropriate management.

Results: In our series, typhoid perforation commonly occurred in second and third decade of life (70%) with male preponderance and 44% of cases occurred 8-14 days of onset of fever. Pain abdomen and dehydration being the most common presentation occurring in all patients. Pneumoperitoneum in chest X ray and erect x ray abdomen was seen in 78% of patients. Widal was positive in 86% of patients of typhoid perforation in this series. In our study lag period was between 1 hour and 96 hours with average of 31.66 hours. Over 96% of perforations were within 2 feet from ileocaecal junction. Simple two layer closure is the commonest procedure done. Wound infection is the commonest postoperative complication seen in 31.1% of patients.

Conclusions: We found typhoid fever as the most common etiology for ileal perforation. Widal test is useful in diagnosis of typhoid fever. Ileal perforations have significant morbidity and mortality despite adequate operative intervention and postoperative care. Lag period, hypoalbuminemia, azotemia and shock on admission were found to be significantly contributing to morbidity and mortality.