Ileostomy Versus Primary Closure in Typhoid Ileal Perforation in Patients with Two or More Poor Prognostic Factors.

Background: Typhoid ileal perforation is a life-threatening disease affecting the northwestern Nigeria, with high morbidity and mortality, especially in those with multiple poor prognostic factors. The popular surgical approaches are primary closure of the perforation and ileostomy. It is debatable which approach has better outcomes in our environment. This study compared outcomes of the use of ileostomy to primary closure in patients with two or more poor prognostic factors, assessing 30-day mortality, surgical site infection (SSI), and time to oral intake.

Methodology: The study was conducted at Aminu Kano Teaching Hospital, Nigeria over one year, involving 56 patients randomized into two groups: Group A (ileostomy, n=28) and Group B (primary closure, n=28). Exclusions included moribund patients, non-typhoid ileal perforations, and decompensated systemic diseases. Postoperative complications, mortality, and recovery parameters were analyzed using SPSS version 25, with statistical significance set at p<0.05.

Results: Results showed that 64% of patients were aged 12-20 years. SSI was high in both groups (71.9% ileostomy, 82.1% primary closure). Major complications like burst abdomen (32%) and fecal fistula (32%) occurred only in the primary closure group. Patients with ileostomy resumed oral intake earlier (2.30±0.61 days vs. 3.71±0.76 days). Overall mortality was 14.3%, with higher deaths in the primary closure group (21.4% vs. 7.1% in ileostomy).

Conclusion: While SSI and mortality were more frequent in the primary closure group, the difference was not statistically significant. However, ileostomy demonstrated advantages, including fewer severe complications and faster recovery of enteral feeding. The study suggests that individualized surgical approaches, considering patient risk factors, may improve outcomes in typhoid ileal perforation cases. Ileostomy may be preferable in high-risk patients due to its lower complication rates and quicker postoperative recovery.