Frequency of typhoid-related intestinal perforation with atypical clinical presentation at Tertiary Care Hospital in Pakistan

Abstract

Objective: To determine the frequency of cases with atypical clinical history diagnosed as typhoid-related intestinal perforation (TIP) in a tertiary care hospital.

Methodology: A Cross sectional study was conducted in department of General Surgery, Jinnah Postgraduate Medical Centre, Karachi, from 20th January 2021 to 20th January 2024. Ninety-eight patients meeting the inclusion criteria of age 13-75 and diagnosis of typhoid related intestinal perforation, were enrolled through non-probability consecutive sampling. Data was collected after taking an informed verbal consent in self-designed proforma. SPSS version 25 was utilized for data analysis. A P-value of ≤ 0.05 was considered as significant.

Results: Median age was 23 (18, 35) years with 82.7 % male predominance. Out of ninety-eight cases, 96.94% (95) had at least one atypical clinical feature while 23.49% (23) had all three atypical features at presentation. About 75.5% (74) of the cases had atypical duration of illness (≤14 days or >21 days). 76.53% (70) had atypical fever pattern (other than continuous step ladder). 5.1% (5) were afebrile, also considered as atypical. 41.84% (41) had atypical bowel habits (normal). Most common time of presentation was week-one 38.8% (38), followed by week-three, week-two and beyond week-three. The most common fever pattern was intermittent 66.3%, followed by continuous, remittent and relapsing. Constipation was more common 58.16% (57) than diarrhea 41.84% (41).

Conclusion: Majority of patients with TIP had short duration of illness and intermittent pattern of fever, which were prone to be misdiagnosed due to their atypical presentation. Such cases must come into consideration for timely and adequate management of the disease.