Typhoid fever is a syndrome that is caused by Salmonella enterica serovar Typhi. It is gram-negative bacteria and belongs to the family of enterobacteriaceae. This disease is mainly spread through the drinking of contaminated water or consumption of food that contain the feces of infected person or asymptomatic carriers. Incubation period of this infection is 1 to 2 weeks and may extend to 60 days.1 This disease is characterized by persistent fever and many additional signs and symptoms such as dry cough, diarrhea, constipation, stomach pain and lethargy.2 The disease-causing organism is a multi-organ pathogen that infects bloodstream of affected individuals, the lymphatic tissue of the small intestine, spleen and liver.3 Enteric fever is more common in children over the age of five, and complications have occurred in more than one-third of recorded cases.4 in Pakistan the reported incidence in children  2-5 years of  is 573.2.  It was predicted that 451.7 out of 100,000 cases occur each year in children aged 2- 15 years. Its rate was much greater in countries of south Asia, including Pakistan, compared to southeast and northeast regions of Asia.5 Typhoid fever is known to cause a variety of problems. Ileal perforation is one of the most deadly complications 6 and a common surgical emergency.

However, surgery is regarded as certain treatment, and the particular surgical method choice remains controversial.7 Most studies revealed that simple perforation closure and resection, as well as anastomosis in patients with numerous perforations, resulted in good outcomes.8-9 These surgical treatments sound attractive, especially in an emergency situation, but they are not without dangers. Although the mortality rate is reducing, it remains quite high, ranging from 1 to 39%, with considerable morbidities despite advances in therapy.10 However, procedures are linked with a greater risk of morbidity and death, but give significant survival chances.11 It is thus crucial to gather data on this frequent infectious disease and gain insight into the pattern of typhoid fever and its associated surgical complications, which are linked with high morbidity and death. Therefore the present study was carried out to find out the   pattern of presentation, complications and outcome of typhoid ileal perforation.

The present descriptive cross-sectional study was carried out at the department of General Surgery Bolan Medical complex Hospital Quetta from September 2025 to February 2026 after taking permission from the ethical committee of the hospital. Individuals of both genders and different age groups diagnosed with typhoid ileal perforation based on, operational results, blood cultures, clinical symptoms, and biopsy reports were included. Individuals with intestinal perforation from other causes including trauma and tuberculosis were excluded. The sample size was determined using the WHO calculator. The required sample size was 102.The study participants who had typhoid-ileal perforation with fever, constipation, abdominal pain were examined for absent bowel sounds and gas under diaphragm on x-ray chest, abdominal tenderness stiffness and rebound tenderness. Blood samples were collected and submitted for culture and sensitivity. A history of antibiotic use was also noted. An exploratory laparotomy was performed, and operative results such as single or multiple ileal perforations, location and size of the perforation were noted. A biopsy was obtained from the margin of the perforation and submitted for histology. A sample of peritoneal fluid was collected for culture and sensitivity analysis. Primary perforation closure was performed in individuals with a single perforation; whereas loopileostomy was performed in individuals with numerous perforations as well as those who arrived late. Complications following surgery such as peritoneal abscess, infection of the wound, and ruptured abdomen were reported. When requested, a re-exploration was performed and an ileostomy was created. Stoma-related complications and fatality rates were documented using a pre-designed form. Data was analyzed using SPSS version 26. Categorical variables, such as the frequency of causes and complications, were reported as numbers and percentages. Numerical variables such as age were presented as mean + SD.

In this study a total of 102 individuals with typhoid ileal perforation were enrolled out of which 62(67.7%) were male 40 (39.2%) were females. The mean age of the study population was 2611.23 years. Single perforation was seen in 80(78.4%) cases and multiple perforation was noted in 22(921.6%) cases.60 (58.8) individuals had history of fever more than 7 days and 42(41.3%) had fever less than 7 days as presented in table 1. 40(39.21%) individuals had done ileostomy and 62(60.7%) performed primary repair  of perforation. Positive blood culture was observed in 26(25.4%) cases. 62 (60.7%) individuals had signs and symptoms of acute peritonitis that lasted for 48 hours. The histopathology examination for each individual revealed signs of enteric fever. 9 (8.82%) participants died in this cohort. Those who died from shock presented late and required ventilator assistance. Our study identified a number of complications, including ruptured abdomen 17(16.7%), paralytic ileus 4(3.9%), wound infection 35(34.3%), re-exploration 5(4.9%), and stoma-related issues 6(16.2%). Morbidities associated with typhoid ileal perforation has been explained in table 2.

Typhoid fever, caused by salmonella typhi, is the leading cause of ileal perforation, with a death rate of up to 30%.12 It is spread by contaminated water and food.13 Typhoid is more prevalent in low socioeconomic categories due to inadequate sanitation and intake of polluted water. Patients often exhibit a step-ladder pattern of fever, gastrointestinal pain, vomiting, abnormal vital signs, especially abdominal pain and tenderness. Perforation is frequently seen in the distal ileum, affecting the antimesenteric bladder.14 perforation caused by Typhoid is a severe complication with a high mortality rate.Surgery for typhoid perforation can lead to wound infection, ruptured abdomen, enter cutaneous fistula, and prolonged hospital stay. Ileostomy is usually recommended for these individuals. Ileostomy problems include prolapse, retraction, necrosis, and non-functioning stomas.15 Ileostomy also affects a patient's quality of life. Recent cases of drug-resistant enteric fever led to worry.16 Collecting data on typhoid fever and its surgical complications is crucial for understanding the disease's impact on morbidity and death rates. In this study a total of 102 individuals with typhoid ileal perforation were enrolled out of which 62(67.7%) were male 40 (39.2%) were females. The mean age of the study population was 26.01±11.23 years. Single perforation was seen in 80(78.4%) cases and multiple perforation was noted in 22(921.6%) cases.60 (58.8) individuals had history of fever more than 7 days and 42(41.3%) had fever less than 7 days. Our findings are similar to the study conducted by Hadees eta al in which similar typhoid ileal perforation and pattern of presentation were reported.17 In our study majority of the participants were male. Typhoid perforation typically affects male patients aged 17 to 31.18 The study's patients had a mean age of 26.01±11.23 years and were mostly male, as described in the literature. This may be related to their eating habits, as they often labor outside and consume contaminated food. This emphasizes inadequate quality control in the food sector at cafes. To prevent the spread of Salmonella typhi, hotel and restaurant cooks should be checked for the disease. Our study identified a number of complications, including ruptured abdomen 17(16.7%), paralytic ileus 4(3.9%), wound infection 35(34.3%), re-exploration 5(4.9%), and stoma-related issues 6(16.2%). These findings are similar to the study conducted by Hadees eta al. The most prevalent complication with typhoid ileal perforation was ruptured abdomen, wound infection and paralytic ileus reported in their study.17 in our study 40(39.21%) individuals had done ileostomy. Complications from stoma development included prolapse and bowel dysfunction. Local stoma care can reduce ileostomy-related excoriation, a frequent observation. Other studies showed a similar tendency.19

The present study concluded that typhoid ileal perforation resulted in severe postoperative complications and death. Prompt diagnosis and early surgery are critical for better outcomes.