A Case of Typhoid Fever with Massive Intestinal Hemorrhage and Perforation Requiring Surgical Management

Naoyuki Kaneko, Katsushi Okamoto*, Hiroo Mukaiyama*, Tomomi Senoh*

Department of Traumatology and Critical Care Medicine, National Defense Medical College Hospital
*Department of Surgery, Kamo Hospital

This report describes a case of severe typhoid fever (TF) requiring surgical management, which is very rare in Japan. A 63-year-old man had been admitted elsewhere with fever of unknown origin. He was transferred to our facility ten days later, in shock with massive melena. Angiography revealed extravasation of contrast medium from a branch of the ileal artery. At an emergency laparotomy, active bleeding and penetration were found in the ileum. The ileum and mesentery, with palpable indurated lesions, were resected. Salmonella typhi was isolated by blood culture. Angiography for massive typhoid hemorrhage has been recommended in a few reports. The classical approach to the management of intestinal hemorrhage and perforation due to TF has been conservative, but emergency surgical intervention has recently been recommended. Although several operative procedures have been reported, it seems to be important to resect thoroughly the intestine and mesentery which include typhoid lesions. In the diagnosis and treatment of lower intestinal hemorrhage and/or perforation, TF should not be forgotten as a possible cause, and it is important to have a thorough knowledge of the intestinal characteristics of TF.

Key words
lower intestinal hemorrhage and perforation, angiography, surgical management of typhoid fever

Reprint requests
Naoyuki Kaneko Department of Traumatology and Critical Care Medicine, National Defense Medical College Hospital
3-2 Namiki, Tokorozawa, 359-8513 JAPAN

Accepted
June 10, 1998

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