ENTERIC FEVER AND GI PERFORATION IN EMERGENCY PRESENTATIONS. A CLINICAL REVIEW AND MANAGEMENT ALGORITHM
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Keywords
Enteric fever, gastrointestinal perforation, emergency surgery, diagnostics, antimicrobial resistance, management algorithm.
Abstract
GI perforation during enteric fever is a surgical emergency with a high mortality rate, especially in low- and middle-income countries, due to late diagnosis and poor resources. In spite of all the innovations in diagnostic and therapeutic measures, a unified evidence-based management protocol is absent. This was conducted to assess the clinical manifestations, diagnostic tools, surgical measures, and antibiotic sensitivity in patients with enteric fever-associated GI perforation, and to propose an evidence-based clinical management algorithm to improve the outcomes of emergency care. A prospective and retrospective study was done over 6 years at an institution named Sher-i-Kashmir Institute of Medical Sciences (SKIMS), and it captured 120 patients who presented with peritonitis or acute abdominal pain, which was confirmed to be enteric fever-related GI perforation during an operation. The data on demographics, diagnostic accuracy, interventions, microbiological profiles, and postoperative outcomes were examined. Multimodal diagnostics improved the accuracy of detection with ultrasonography giving 78 per cent sensitivity, plain abdominal radiography 70 per cent, and CT scans 96 per cent sensitivity and 94 per cent specificity. Of the surgical patients, 72 percent underwent primary repair and 28 percent stoma creation, with intraoperative complications observed in 6 percent. Only 2% mortality was reported postoperatively. Susceptibility to antibiotics showed that it had high sensitivity to ceftriaxone (92 percent), azithromycin (85 percent), and metronidazole (90 percent), but a high resistance to fluoroquinolones (60 percent) and ampicillin (65 percent). Multimodal diagnostics, personalized surgery, and culture-based antibiotic therapy led to positive clinical outcomes and minimized the mortality rates. The proposed management algorithm will provide a standard, scalable model of delivering ameliorated emergency surgical care in enteric fever-related GI perforation.
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Dr Wajid Ali Gazi
Registrar Dept of Emergency Medicine, SKIMS Soura Srinagar
Dr Sibit Showkat
Registrar Dept of Anaesthesia, GMC Srinagar,