Typhoid intestinal perforation in developing countries: Still unavoidable deaths?

Table 1 Reported experiences with typhoid vaccination strategies[37]

Vaccination strategies	Countries
Preemptive community-based routine vaccination	China, India
Preemptive community-based routine vaccination campaign	China, India, Pakistan, Vietnam
Preemptive disaster-response community-based vaccination campaign	Fiji, India Pakistan
Preemptive school-based vaccination	Chile, China, Indonesia, Nepal, Pakistan, Vietnam
Reactive (outbreak response) community-based vaccination campaign	Fiji, Tajikstan
Reactive (outbreak response) school-based vaccination	China

Table 2 Prospective studies reported in literature about surgical management of typhoid intestinal perforation

Ref.	Conclusions
Haider et al[60], 2002	Late presentation, delay in operation, multiple perforations, and drainage of copious quantities of pus and fecal material from the peritoneal cavity adversely affected the incidence of fecal fistula and the mortality rate.
Adesunkanmi et al[50], 2003	Peritonitis assessment by APACHE II score (50% perforations). A modified APACHE II score greater than 15 was associated with a significantly greater mortality.
Bashir et al[67], 2003	Primary ileostomy vs simple repair vs resection anastomosis: ileostomy is a good life saving procedure (statistical evaluation not reported).
Shukla et al[68], 2004	Single layer vs double layer repair: good closure of the perforation rather than single- or double-layer repair that determines the outcome in patients with enteric perforation.
Edino et al[55], 2007	Mortality is significantly affected by multiple perforations, severe peritoneal contamination and burst abdomen.
Gedik et al[58], 2008	Mannheim Peritonitis Index and perforation-operation interval were found independent risk factors affecting morbidity.
Mohil et al[57], 2008	Disease severity assessed by POSSUM score. Severity of disease rather than surgical procedure has a significant impact on the outcome.
Pandey et al[69], 2008	T-tube inserted into the bowel lumen after closing all distal perforations vs primary closure vs resection. In children with multiple perforations and poor general condition, the use of T-tube may be an effective management option (statistical evaluation not reported).
Tade et al[59], 2011	ASA class is a significant predictor of mortality in patients treated for typhoid intestinal perforation.
Ibrahim et al[70], 2014	Single layer vs double layer repair: single layer repair of the perforated ileum due to typhoid enteric perforation with peritonitis in children was effective by reducing complication rates.
Chaudhary et al[75], 2015	Temporary loop ileostomy for perforation peritonitis due to benign systemic diseases like typhoid fever and tuberculosis confers a very high morbidity.