CHAPTER I
INTRODUCTION
Typhoid fever is a systemic disease caused by Salmonella typhi. The disease is characterized by prolonged heat, the prop with bacteremia without getting involved or endokardial endothelial structure and invasion of bacteria into the cell multiplication as well as mononuclear phagocytes of the liver, spleen, lymph nodes and intestinal Peyer's patches. Until now, typhoid fever remains a public health problem, and associated with poor sanitation, especially developing countries.
In developing countries, the estimated incidence of typhoid fever varies from 10 to 540 per 100,000 population. Although the incidence of typhoid fever came down with a sanitary disposal in many developing countries, estimated that each year there are 35 million cases with 500,000 deaths in the world there. Typhoid fever in Indonesia is still an endemic disease with an incidence rate is still high. Among the diseases that are categorized as intestinal infectious diseases, typhoid fever ranks second after gastroenteritis. 1
Gastrointestinal perforation is a complex form of penetration of the wall of the stomach, small intestine, large intestine result from leakage of intestinal contents into the abdominal cavity. Perforation of the colon can potentially lead to the occurrence of bacterial contamination in the abdominal cavity (a condition known as peritonitis). Gastric perforation developed into a chemical peritonitis caused by leakage of stomach acid kedlam abdominal cavity. Perforation in any form of gastrointestinal distress is a surgical case. 3
In children, injury to the small intestine caused by blunt abdominal trauma from a very rare with 1-7% incidence. Since 30 years ago merupakn peptic ulcer perforation in a common cause. Perforated duodenal ulcer incidence is 2-3 times more than a perforated gastric ulcer. Nearly 1/3 of gastric perforation due to gastric malignancy. Approximately 10-15% of patients with acute diverticulitis can develop into free perforation. In the older patients had a mortality rate of appendicitis acuta as much as 35% and 50% morbidity. The main factors that contribute to morbidity and mortality in these patients is a severe medical conditions that accompany such appedndicitis.
Perforation of the gastrointestinal tract is often caused by diseases such as gastric ulcer, appendicitis, gastrointestinal malignancies, diverticulitis, superior mesenteric artery syndrome, trauma. 2
