Surgery and Healing in the Developing World - Dartmouth-Hitchcock

Abscesses and Other Infections Treated by Surgery
Figure 19. Typhoid perforation
of the terminal ileum.
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and electrolyte resuscitation have been achieved. If there is no free air, a diagnostic
open peritoneal lavage can be done under local anesthesia in the midline one-inch
below the umbilicus after draining the bladder by catheter to rule-out or treat a
distended bladder and avoid damage to the bladder. If pus or intestinal contents are
returned after lavage with a litre of warm sterile saline, explore the abdomen or refer
the patient for exploration immediately. If perforated peptic ulcer is suspected, start
the incision in the upper abdomen. Otherwise use a long midline incision to give
full access to the abdomen.
At exploration, examine the entire abdomen and subphrenic regions and the
entire length of the intestines. To treat a perforated duodenal ulcer, a patch of attached
omentum is sutured over the perforation without attempting to suture the
hole closed. A similar method may be used in early typhoid perforation (usually of
terminal ileum as in Fig. 19) if there are no more than three sites of perforation and
Figure 20. Pott’s (tuberculous) abscess
of the thoraco-lumbar spine appearing
as a round shadow.
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