Typhoid perforation: determinants of outcome in children in Ile-Ife, Nigeria

Abstract

Background: Ileal perforation can be a fatal complication of typhoid fever in children as its clinical presentation is often atypical.  The risk of death from intestinal perforation in typhoid fever is more than four times when compared with patients without perforation. A high index of suspicion therefore, and early intervention are mandatory to reduce morbidities and deaths due to this disease in children.

Aim: To highlight the factors that adversely influence treatment outcome following typhoid ileal perforation in a  paediatric population and how they could be modified to reduce morbidity and mortality.   

Methods: This was a retrospective study whereby medical records of children aged 1 to 15 years with typhoid fever admitted to OAUTHC, Ile-Ife, over a 10-year period, 1994-2004.

Results: A total of 38 patients, 20 males and 18 females in the   ratio  1.1:1,  were   managed   for typhoid perforation during the 10-year study period. Twenty-nine patients (76.3%)

survived while 9 (23.7%) died.  Of the many factors evaluated, only the duration of time before operation was found to significantly influence treatment outcome adversely (P=0.009), while large single or large multiple perforations (P=0.256), severe peritoneal contamination (P=0.291) and extensive surgery (P=0.089) did not.

Conclusion: Typhoid ileal perforation  has a poor treatment outcome in children in Ile-Ife, Nigeria.  The duration of time before operation was  the single most important factor that adversely affected treatment outcome. Therefore, swift preoperative resuscitation and early surgical intervention will enhance overall outcome irrespective of the number of perforations, severity of faecal contamination and extent of surgery.

Keywords: Typhoid perforation, Determinants of outcome, Children, Nigeria