TYPHOID PERFORATION CASE STUDY

Typhoid perforation 

Here is a documented case study on Typhoid Perforation with client care details.

Case Study on Typhoid Perforation

Patient Information

Name: A.A. (Initials for confidentiality)

Age/Sex: 26-year-old male

Occupation: Student

Residence: Rural area with poor sanitation

Date of Admission: March 10, 2025

Chief Complaint

Severe abdominal pain (started 3 days ago, worsening).

Fever (high-grade, on and off for 2 weeks).

Vomiting and diarrhea (bloody stools).

Abdominal distension and tenderness.

History of Present Illness

Patient had a two-week history of fever, chills, and body weakness, treated at home with herbal remedies.

Developed persistent abdominal pain, worsened over 3 days.

Experienced vomiting, reduced appetite, and loose stools.

Self-medicated with antibiotics from a local pharmacy, but symptoms persisted.

Referred to hospital after sudden worsening of pain and abdominal swelling.

Past Medical History

No history of peptic ulcer disease, appendicitis, or previous abdominal surgery.

No known chronic illnesses like diabetes or hypertension.

Physical Examination Findings

General Appearance:

Ill-looking, dehydrated, in distress due to pain.

Vital Signs:

Temperature: 39.2°C (Fever)

Pulse Rate: 120 bpm (Tachycardia)

Blood Pressure: 90/60 mmHg (Hypotension)

Respiratory Rate: 24 bpm (Tachypnea)

Abdominal Examination:

Severe tenderness, guarding, and rigidity.

Absent bowel sounds.

Rebound tenderness positive (Blumberg’s sign).

Diagnostic Tests & Results

Complete Blood Count (CBC): WBC 16,500/mm³ (Leukocytosis, sign of infection).

Blood Culture: Positive for Salmonella typhi.

Serum Electrolytes: Hypokalemia (K+ = 3.0 mmol/L).

Abdominal X-ray: Free air under the diaphragm (suggestive of perforation).

Abdominal Ultrasound/CT Scan: Fluid collection in the peritoneal cavity.

Diagnosis

Typhoid Intestinal Perforation with Peritonitis

Treatment & Client Care

1. Preoperative Management

Nil Per Oral (NPO) – Prevent further contamination.

Intravenous (IV) Fluids:

Normal saline, Ringer’s lactate to correct dehydration.

Nasogastric Tube (NGT) Insertion – To decompress the stomach.

IV Antibiotics:

Ceftriaxone 2g IV 12 hourly + Metronidazole 500mg IV 8 hourly.

Pain Control:

IV Paracetamol + Morphine (if needed).

Vital Signs Monitoring: Every 2 hours to check for worsening sepsis or shock.

Blood Transfusion: Packed red blood cells for severe anemia.

Preoperative Counseling: Informed consent for surgery.

2. Surgical Intervention

Emergency Exploratory Laparotomy

Findings:

Single perforation in the ileum (~30 cm from the ileocecal valve).

400 ml of pus in the peritoneal cavity.

Surgical Procedure:

Segmental resection with end-to-end anastomosis (closure of perforation).

Peritoneal lavage with warm saline.

Drain placement in the pelvic cavity.

3. Postoperative Care

ICU Admission (due to high risk of sepsis).

Continuous IV Fluid Resuscitation.

Ongoing IV Antibiotics for 7–10 days.

NGT Maintenance (until bowel function returns).

Pain Management – IV paracetamol/morphine as needed.

Early Mobilization – Prevent deep vein thrombosis.

Daily Wound Care – Monitor for signs of infection.

4. Outcome & Follow-up

Day 3 Post-op: Patient tolerated oral fluids.

Day 5 Post-op: Bowel movements resumed, transitioned to a soft diet.

Day 7 Post-op: Drain removed, vital signs stable.

Day 10 Post-op: Discharged with oral antibiotics (Ciprofloxacin 500mg BD for 10 days).

Follow-up After 2 Weeks: Healing well, no complications.

5. Health Education & Prevention

Safe Water Consumption: Boil or treat drinking water.

Hand Hygiene: Regular washing with soap.

Proper Food Handling: Avoid street food, wash fruits/vegetables well.

Complete Vaccination: Typhoid vaccine recommended.

Regular Health Check-ups: Report early symptoms like prolonged fever.

Conclusion

This case study highlights the life-threatening complications of untreated typhoid fever. Timely diagnosis, surgical intervention, and proper post-op care were crucial in ensuring the patient’s survival. 

Preventive measures such as hygiene, vaccination, and safe drinking water remain key in controlling typhoid fever, especially in endemic areas.