Salmonellosis에 대한 외과적 고찰

Abstract

[한글]

[영문]

Since Eberth isolated Salmonella species in1980, now it has been known more than

400 species and most of them are said to have potential pathogenecity for human,

but a few species make clinical problem such as S. paratyphosa and S. typhi.

Although typhoid fever is a disappearing disease, stil it has relative high

mortality and severe systemic toxic effects which so often results in complications

requiring surgery.

Author has reviewed 565 cases of confirmed salmonellosis by serological test

pathology at Severance Hospital from Jan. 1961 to Dec. 1970.

The purpose of this article is to provide not only a stastical analysis of

typhoid fever nut also special reference to surgical complications and it's

prognosis.

The analytical data are as follows :

1. over-all sex distribution was roughly similar, male(303) and female(262), but

in cases of perforation male outnumbered femalein a 4:1 ratio.

2. The peak age incidence was in 3rd decade and most of the patient belongs to

2nd to 5th decade.

3. Seasonal incidence showed more common in summer, fall and winter until 1965,

but recently seasonal difference seems to be changed.

4. Most of the patient complains of fever chills, abdominal pain, diarrhea and

vomiting, rarely cough, dyspnea, headache and bloody stool.

5. Common physical findings were hepatomegaly, abdominal tenderness and

splenomegaly.

6. Leucopenia was noted in 15.0% of total cases and 7.5% in perforated cases.

7. Serology showed positive in 46.2%, of which 76.5% was S.typhosa.

8. Liver function tests showed abnormality in B.S.P., alkaline phosphatase,

S.G.O.T., and S.G.P.T. in over 60% of the cases.

9. Blood cultures showed positive in about 33%, stool culture 11% and culture

0.5% of the cases.

10. Typhoid nodule was found in 3 cases in liver biopsy specimen.

11. The incidence of complication was 14.6% and 6.4% required surgery.

12. Over 78% of perforation occurred within 50cm proximal to the ileocecal valve.

13. Three types of operative methods were used, those were primary closure,

resection and anastomosis, resection and exteriorization.

14. Mortality rate was 1.06% and operative mortality was 5.2%.

15. With the advent of specific antibiotics, the clinical picture has been much

cahnged, and that the phenomenon of episomer transfer resistance has made much

difficulties in medical treatment as well as in surgical treatment.