Typhoid Intestinal Perforation in Children: Still a Persistent Problem in a Developing Country

Abstract

Background: Typhoid intestinal perforation is serious complication of typhoid fever and is associated with significant morbidity and mortality in developing countries. The aim of this study was to determine the incidence, pattern and outcome of treatment of typhoid intestinal perforation (TIP) in children in a teaching  hospital in Enugu, Nigeria.

Methods: This was a retrospective study of patients aged 15 years and below operated on for TIP in the pediatric surgery unit of Enugu State University Teaching Hospital (ESUTH) Enugu, Nigeria. Medical records of pediatric patients who had laparotomy for TIP over a 10-year period were evaluated.

Results: There were 200 cases of TIP and this accounted for 35.7% of all pediatric surgeries performed during the period of the study. There were 150 (75%) males and 50 (25%) females which correspond to a male female ratio of 3:1. The ages of the patients ranged from 6 to 15 years with a median of 11 years. One hundred percent of the patients had fever and abdominal pain. Anemia, hypokalemia and a single ileal perforation were recorded in most of the patients. Primary closure of the perforation was the most common performed surgical procedure. Surgical site infection, burst abdomen and residual intra-peritoneal abscess accounted for most of the post-operative complications. Mortality was 8.5%.

Conclusions: TIP is still a problem in developing countries due to absence of potable drinking water, poor hygiene and improper waste disposal.

Keywords: Developing country; intestinal perforation; typhoid; persistent