Typhoid intestinal perforation in children: a continuing scourge in a developing country

Abstract

Typhoid intestinal perforation is a principal cause of morbidity and mortality affecting both adults and children. This study aims to evaluate the pattern of typhoid intestinal perforation and outcome of its management in Nigerian children. The records of consecutive children managed for typhoid intestinal perforation at Juth, between 1996 and 2005 have been reviewed. There were 184 children (M:F = 1.04:1), with a mean of 5.8 years (range 4 to 15 years). More than a half (62.5%) of the patients were in the 5-6 year age group. The incidence peaked in April-May, and November-December. Increased incidence of typhoid perforation was observed between 2002 and 2005. All patients presented with the classic features of typhoid enteric perforation. Hypokalaemia and anaemia were common at presentation. Only 75 (40.6%) patients had operation within 24 h of perforation. The types of surgery included simple excision of the edges of the peroration and closure (74.5%), wedge resection and closure in (14.5%), segmental resection with primary end-to-end anastomosis (3.6%) and right hemi-colectomy with ileo-colic or ileo-transverse anastomosis. Wound infection and dehiscence, anastomotic breakdown with faecal fistula, intra peritoneal abscesses and chest infections were the main post operative complications. The overall mortality rate was 22.8 (42). Excision and simple closure was associated with the least incidence of anastomotic breakdown and operation time. The incidence of typhoid intestinal perforation is on the increase at our institution. Early limited surgery provides optimal results.

Typhoid perforation in children: an unrelenting plague in developing countries

“…Our study showed that almost all patients exhibited the classical triad of TP symptoms. This finding was similar to that of Uba et al [22] where all patients manifested with the classical features of TP. Perhaps this could be attributed to late presentation of the patients at which time the clinical features were already well established.…”

“…The pathophysiology of anaemia is said to be multifactorial and includes bone marrow suppression, haemophagocytosis, sepsis and malnutrition [11,17] . Similar to many other reports [5,17,[22][23], the majority of perforations were singular in both genders. Our findings, in agreement with those of the Zaria series [5], showed that the perforation rate increased with age, though there was no significant statistical difference following this observation.…”

“…In this study, as in others [5,17,[22][23], excision of the edge of the perforation and simple closure was the predominant surgical procedure performed. This is in agreement with the position that the simple, quick and effective procedure was the best choice because these were high surgical risk patients [17,27].…”

“…The mortality rate recorded in this series compared with that of an earlier report by Archibong et al [20] from the same centre but is far lower than those from others [5,22]. Aside from variation in sample size, the difference in mortality rate may be due to availability of more recent and potent antibiotics to combat the systemic effects of the disease following surgical intervention.…”

Typhoid fever in sub-Saharan Africa: Challenges of diagnosis and management of infections

“…However, a number of hospital-based surveillance and case reports from several African countries suggests that typhoid is indeed a major public health concern, especially among school-age children. An earlier incidence study in Mali by Ferreccio et al [4] confirmed that S. Typhi and S. Paratyphi A were major causes of bacteremia among children younger than 2 years of age, while in Nigeria cases of ileal perforation due to typhoid were common in children younger than 5 years of age [5]. A breakdown in the portable water system in a South African suburb caused an outbreak of typhoid , causing illness in nearly 4,000 persons as well as several deaths [6].…”