Background: - Typhoid fever is a disease caused by salmonella typhi, a gram-negative bacillus. Ileal perforation is a common drawback seen in tropical countries. The commonest cause is typhoid fever. In western countries, the causes are malignancy, trauma, and mechanical ethology. Intestinal perforation is a common cause of the occurrence of peritonitis necessitating emergency surgical intervention.

Methods: - An observational study was conducted on 50 cases of typhoid ileal perforation admitted in the Department of Surgery, Rajendra Institute of Medical Sciences, Ranchi during the period of November 2019 to September 2021. The study aimed to find out the presentation, management, outcome, and factors influencing the outcome of patients admitted with ileal perforation

Results: - Typhoid ileal perforation commonly occurred in the second and third decades with 62% of cases in that age group. Abdominal pain, fever, and vomiting were the commonest symptoms. The commonest signs were dehydration, abdominal tenderness, guarding, and intra-abdominal free fluid. Pneumoperitoneum in the chest and erect abdominal X-ray was seen in 78% of patients. The Widal test was positive in 22 patients out of 40 tested (55%). The histopathological report was suggestive of typhoid in three patients (20% of tested). Ileostomy was the commonest procedure done (64%). Two-layer closure was done in 24% and resection and anastomosis in 8% of patients. The mortality rate was 14%.

Conclusion: - Typhoid is the most common cause of Ileal perforation with male preponderance. Widal serology has been proven to be a useful test in the diagnosis of typhoid fever. Typhoid perforations have a higher morbidity rate. The type of surgical procedure did not influence the outcome, either morbidity or mortality.