Typhoid ileal perforation: Analysis of morbidity and mortalityin 89 children

Abstract

Typhoid ileal perforation is still prevalent in many developing countries. Despite the advances in The management, the outcome in children is still very poor. To determine the morbidity and mortality of childhood typhoid ileal perforation in a tertiary referral centre in southeast Nigeria Retrospective evaluation of 89 children operated for typhoid ileal perforation over a 10-year period (January 1, 1995 through December 31, 2004) at the University of Nigeria Teaching Hospital, Enugu. There were 54 (60.7%) boys and 35 (39.3%) girls aged 1 15 years (mean 9.1 years). Thirty-nine (43.8%) were >10 years. Fever and generalized abdominal pain were the predominant symptoms for 5 21 days (mean 13.4 days) and 2 13 days (mean 8.8 days) respectively before presentation. Seventeen (89.5%) of those <5 years had vomiting. Pneumoperitoneum was demonstrated radiologically in 59 (66.3%) children. Surgical treatment involved simple closure in 46 (51.7%) children and segmental intestinal resection in 43 (48.3%). Surgical site infection 41 (46.1%), chest infection 21 (23.6%) and reperforation 19 (21.3%) were the commonest postoperative complications. The overall mortality was 17 (19.1%) from overwhelming infection. Age < 5 years and prolongation of perforation-operation interval worsened morbidity and mortality. Typhoid ileal perforation in childhood is associated with high morbidity and mortality. Outcome can be improved by early presentation and intervention. Typhoid fever, ileal perforation, morbidity, mortality.

Keywords: Typhoid fever; ileal perforation; morbidity; mortality; childhood

Nigerian Journal of Clinical Practice Vol. 11 (1) 2008: pp.59-63