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This was a case of Typhoid ileal perforation where laparoscopic repair of perforation done .The perforation was closed with interrupted vicryl suture.thorough peritoneal lavage...

This was a case of Typhoid ileal perforation where laparoscopic repair of perforation done .The perforation was closed with interrupted vicryl suture.thorough peritoneal lavage was done with plenty of normal saline and an abdominal drain was place inside before coming out from abdomen. Discussion-/nTyphoid ileal perforation is very common in developing and under developed countries. It has high morbidity and mortality rate with ranges between 9 and 43%, with high incidence of severe wound infection and history of long hospital stays. Many factors, such as late presentation, adequate pre-operative resuscitation, delayed operation, the number of perforations, and the extent of faecal peritonitis, have been found to have a significant effect on the prognosis./nWhen diagnosed as ileal perforation, patient should be planned for emergency surgery either open or laparoscopic method. If one is surgically expert in laparoscopic surgery then he can go for laparoscopic repair of ileal typhoid perforation with primary closure of perforation and thorough peritoneal toileting./nBefore surgery patient needs proper resuscitation with intravenous fluid, intravenous antibiotics like ceftriaxone, metronidazole. Electrolyte imbalance to be corrected and hourly urine output will give the hydration status of the patient. Normal serum electrolyte and urea are considered as good indicator of resuscitation./nWhen surgery is done open method a long midline or paramedian incision is given. All pus and contamination to be removed and thorough peritoneal lavage with copious amount of normal saline to be done. The perforation site to be identified, the margin of perforation to be sent for histopathology study. Single perforation to be closed with primary repair with 3-0 vicryl with second layer with 3-0 silk suture. Drains were inserted to drain the right paracolic gutter and the pelvic cavity and attached for continuous drainage./nWhen done laparoscopically if single perforation present with limited contamination then the surgical outcome is good./nBut if there is multiple perforation with gross contamination then it is better to go for open repair method./nTime of presentation, amount of contamination, number of perforation , pre op patient patient resuscitation all influence post operative outcome in case of typhoid ileal perforation./nComplications of single perforation are like - wound infection, wound dehiscence and residual intra-abdominal abscess, chest infection, pleaural effusion all can be encountered and to be managed accordingly.