Typhoid & Tuberculous

Perforations of Small Intestines

Introduction:

Perforations of the small intestines caused by typhoid fever and tuberculosis are serious complications of these infectious diseases. Typhoid perforations occur as a result of ulcers in the intestinal wall caused by Salmonella typhi bacteria, while tuberculous perforations result from the erosion of the intestinal wall by Mycobacterium tuberculosis bacteria.

Understanding Typhoid & Tuberculous Perforations:

• Typhoid Fever: Typhoid fever is a systemic infection caused by the bacterium Salmonella typhi. It primarily affects the gastrointestinal tract, leading to the formation of ulcers in the intestinal mucosa. In severe cases, these ulcers can penetrate through the intestinal wall, resulting in perforation.
• Tuberculosis: Tuberculosis is an infectious disease caused by the bacterium Mycobacterium tuberculosis. While it primarily affects the lungs, it can also involve other organs, including the intestines. Tuberculous enteritis occurs when tuberculosis affects the intestines, leading to the formation of ulcers and subsequent perforation.

Characteristics of Typhoid & Tuberculous Perforations:

• Location: Typhoid and tuberculous perforations most commonly occur in the ileum, which is the last part of the small intestine.
• Etiology: Typhoid perforations result from the erosion of intestinal ulcers caused by Salmonella typhi infection, while tuberculous perforations occur due to the erosion of ulcers caused by Mycobacterium tuberculosis infection.
• Severity: Both typhoid and tuberculous perforations are associated with significant morbidity and mortality if not promptly treated. Peritonitis, sepsis, and multi-organ failure are common complications.
• Clinical Presentation: Patients typically present with sudden and severe abdominal pain, fever, abdominal distension, rigidity, and guarding. Signs of peritonitis, such as rebound tenderness and involuntary guarding, may also be present.

Causes and Risk Factors:

• Typhoid Fever: Risk factors for typhoid perforation include poor sanitation, contaminated food or water, and inadequate hygiene practices.
• Tuberculosis: Risk factors for tuberculous perforation include active tuberculosis infection, immunosuppression, malnutrition, and crowded living conditions.

Signs and Symptoms:

• Sudden and severe abdominal pain, often localized to the lower abdomen.
• Abdominal distension and rigidity due to peritoneal irritation.
• Fever, chills, and signs of sepsis.
• Nausea, vomiting, and anorexia.
• Tachycardia, hypotension, and signs of shock in severe cases.