Typhoid ile al pe rforation in childr en: does clinical diagnosis alone jus tify laparotomy?

Abstract

Introduction: Typhoid ileal perforation is one of the most common surgical complications of typhoid fever, with high morbidity and mortality in resource poor tropical areas in Africa and other developing countries.
Objective: The aim of this study was to evaluate clinical diagnosis of  typhoid ileal perforation as justification for laparotomy.
Method: A retrospective study from January 2008 to December 2011 in the Paediatric Surgery Division of the University of Abuja Teaching Hospital.
Results: The age group most commonly affected was aged 6-9 years  (43.5%); there were 20 (43.5%) males and 26 (56.5%) females. The commonest clinical features were fever, vomiting, abdominal pain,  tenderness and distension (52.3%). Thirty one (67.4%) of the patients did not have any diagnostic radiological investigations. Fifteen (32.6%) patients had superficial wound infection, ten (21.7%) died, eleven (23.9%) had no complications.
Conclusion: We advocate that under circumstances where urgent diagnostic radiological and laboratory investigations are not available promptly, clinical diagnosis of typhoid ileal perforation, especially signs of peritonitis should justify an emergency laparotomy.

Key words: typhoid, ileal perforation, peritonitis, laparotomy