Typhoid ileal perforation in Nigerian children: an analysis of 106 operative cases

Rahman, Ganiyu A.; Abubakar, Ahmed; Johnson, A-W.B.R.; Adeniran, JO

doi:10.1007/s003830100008

Cited by 47 publications

(88 citation statements)

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“…[5] The prognosis of typhoid ileal perforation is still poor despite several years of treating it in our societies, with mortality rates ranging from 10% to 25% in children. [5,6] In this study, case fatality for TP was 12.5% and this was as a result of overwhelming sepsis, postoperative continuing peritonitis, wound infection and wound dehiscence. [7] It was noted that mortality among children with multiple perforations (4 or more) stood at 28%.…”

Section: Discussionmentioning

confidence: 84%

The range of abdominal surgical emergencies in children older than 1 year at the komfo anokye teaching hospital, Kumasi, Ghana

2009

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Background: Acute abdominal conditions are a common reason for emergency admission of children. Little is available in the literature about such conditions in our subregion, especially Ghana. Objective: The aim of this study was to investigate the range of emergency abdominal surgical conditions amongst children in the subregion, with particular reference to Komfo Anokye Teaching Hospital, Kumasi, Ghana. A prospective survey of all children older than 1 year undergoing an emergency abdominal surgery was carried out. Methods: Details of all children (except infants) operated for an acute surgical abdominal condition over a 5-year period were entered into a specially designed form, capturing patient characteristics, surgical causes of the emergency, operative procedure, complications, morbidity and mortality rates. Results: Nine hundred fi fty-fi ve children aged Ͼ1 year but Ͻ15 years were enrolled in the study. The mean age was 8.8 Ϯ 3.2 years. The leading causes of surgical abdominal emergencies were typhoid perforation (TP) of the gastrointestinal tract (GIT), 68%; acute appendicitis, 16%; abdominal trauma and intestinal obstruction (including intussusception), 4.7% each; irreducible external hernias, 2.5%; primary peritonitis, 1.0%; gallbladder disease and gastric perforation, 0.8% each. Many children died from the TP group; case fatality for TP alone was 12.6%. The overall mortality was 9.7%. Morbidity was infl uenced by the presence of major peritoneal contamination, continuing peritonitis and surgical site infections (SSIs), which led to long hospital stay. Conclusions: In our hospital, TP of the GIT, acute appendicitis, intestinal obstruction, irreducible external hernias and primary peritonitis were the most common abdominal emergencies encountered in children after infancy. The high morbidity and mortality in TP is attributable to ignorance, poor sanitation and delay in reporting to hospital for treatment.

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Section: Discussionmentioning

confidence: 84%

The range of abdominal surgical emergencies in children older than 1 year at the komfo anokye teaching hospital, Kumasi, Ghana

2009

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“…Similarly, it has also been suggested that infection with multi-drug resistant (MDR: resistant to ampicillin, chloramphenicol, trimethoprim / sulfamethoxazole) S. Typhi may impact clinical severity and outcome although little is known about MDR S. Typhi infection in young children 13 . However, isolation of the organism takes at least 48-72 hours and the yields is often very low at 40-75%, hence limiting its use to a confirmatory basis only 14 . Widal test has become the most commonly used serologic test in the diagnosis of typhoid fever in endemic areas of the developing world where bacteriologic facilities are lacking 15 .…”

Section: Resultsmentioning

confidence: 99%

Age and Gender Difference of Typhoid Fever among Paediatric Patients Attended at a Tertiary Care Hospital in Bangladesh

Sattar

Chowdhury

Yusuf

et al. 2017

Bangladesh J. Infect. Dis.

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“…8 The incidence of typhoid related intestinal perforation is an indication of endemicity of typhoid fever in any locality. 2,9 Enteric perforation is more common in people of lower socio-economic status.This is probably related, poor hygiene and limited access to healthcare facilities.…”

Section: Discussionmentioning

confidence: 99%

“…1 In developing countries, typhoid fever still remains a major health problem because of poor sanitary conditions. 2 Among the various complications the most lethal are intestinal bleeding and ileal perforations, both arising from hyperplasia and necrosis of Peyer's patches in the terminal ileum usually occurring 2-3 weeks after the onset of the disease. 1,3 Although intestinal hemorrhage is the most common complication of typhoid fever, intestinal perforation is the complication associated with highest morbidity and mortality.…”

Section: Introductionmentioning

confidence: 99%

Surgical management and prognosis of perforation secondary to typhoid fever

Jain¹,

Meena²,

Ram³

2016

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Introduction: Enteric perforation is a serious complication of typhoid fever and the condition has a high morbidity and mortality in many developing countries including India. No consensus exists concerning the best procedure to be performed in these cases. Aim: The purpose of this study was to analyse our clinical experience in surgical management of enteric perforation and to determine the prognostic factors associated with morbidity and mortality. Methods: It was a prospective study of patients who underwent surgery for typhoid intestinal perforation at SMS Medical College and Hospital, Jaipur, India, between April 2012 and October 2013. Laparotomy was performed by a midline incision. Management of perforation was based on the intraoperative findings and the procedure to be performed was decided by the operating surgeon. Results: 88 patients were studied with a male to female ratio of 6.3:1. The mean age was 36.4 years. The peak incidence was between 21 to 30 years. All the patients presented with abdominal pain and distension. More than 90% patients showed free gas under diaphragm. 71% patients had a single perforation and 97% patients had perforations confined to ileum. Debridement with double layered closure was performed in about 58% patients, ileostomy in 25% and resection anastomosis in 18% of patients. Overall complication rate was 44.3% with surgical site infection being the most common morbidity. The mortality rate was 17.1% which was significantly affected by perforation-admission interval of more than 48 hours, number of perforations and occurrence of postoperative complications. Conclusion: Typhoid fever leading to development of intestinal perforation continues to be a significant health problem with a high morbidity and mortality especially in rural India. The management of the disease requires an early and appropriate surgical intervention.

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Typhoid ileal perforation in Nigerian children: an analysis of 106 operative cases

Cited by 47 publications

References 0 publications

The range of abdominal surgical emergencies in children older than 1 year at the komfo anokye teaching hospital, Kumasi, Ghana

The range of abdominal surgical emergencies in children older than 1 year at the komfo anokye teaching hospital, Kumasi, Ghana

Age and Gender Difference of Typhoid Fever among Paediatric Patients Attended at a Tertiary Care Hospital in Bangladesh

Surgical management and prognosis of perforation secondary to typhoid fever

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