Background: Despite advances in diagnostic modalities, surgical approach, antimicrobiological therapy and intensive care support, ileal perforations continue to be a potentially fatal affliction in a tropical country. Most ileal perforations are considered to be of typhoid etiology simply based on the clinical presentation of fever of two weeks duration followed by an ileal perforation on the antimesenteric border of terminal ileum.While the surgical management of these perforations does not change a great deal when compared with other causes of ileal perforations, the antimicrobial therapy and the overall outcome is affected by the underlying etiology. Against this background a prospective study was conducted over a period of one year with an aim to establish the underlying pathology and whether these “suspected” typhoid perforations are truly of typhoid etiology. Material and methods: A prospective cohort of fortyseven patients of ileal perforations of suspected typhoid etiology was evaluated over a period of one year. The surgical management was based on a standardized protocol using APACHE II scoring system. Blood culture, peritoneal fluid, ulcer edge and mesenteric lymph nodes biopsies were subjected to culture to determine the predominant aerobic bacterial isolate and its anti microbiological sensitivity. Results :In this series male to female ratio was 36: 11, with an average age of 27.3 years. The average duration of fever was 6.67 days; average hospital stay was 10.14 days with a mortality rate of 17.72%. Salmonella typhi could be isolated in only 10.53% of the patients. Conclusions: The classical presentation of these so called “typhoid perforations” is not commonly observed. Salmonella typhi is rarely isolated from the blood/tissue cultures and the diagnosis of typhoid perforations is essentially clinical. Since ileal perforations are the most common surgical emergency managed by a resident trainee particularly in the developing and underdeveloped countries, a trainee proof and standardized surgical protocol based on APACHE-II scoring system is recommended in order to reduce the mortality.

Key words: Typhoid, enteric, ileal, perforations