Abstract
Objective:To evaluate clinical presentation and surgical outcome in children with enteric perforation.Methods:A descriptive retrospective study was conducted in Department of Paediatric Surgery at National Institute of Child Health, Karachi from August 2016 and September 2019, in children 12 years of age and under with diagnosis of enteric perforation. Data about age, gender, duration of illness, hemodynamic status and baseline investigation on admission was reviewed. Details about patients operated early and those who required prolong resuscitation and were operated after 24 hours of admission, need for tube laparostomy, operative findings, type of surgical procedure performed and post-operative outcome were reviewed. Data was analyzed using SPSS version 22.Results:Ninety-seven patients, 60(61.85%) males and 37(38.14%) females were managed during the study period with age ranged from 3-12 years (mean 7.82, ± 2.94 years).and duration of symptoms ranged from 7-30 days (mean 15.56, ± 9.39days). High grade fever and abdominal pain were seen in all patients (100%). Pneumoperitoneum was noted in 71(73.19%) cases on X-ray abdomen. Fifty-one (52.57%) children were anemic and required blood transfusion before surgery. Seventy-one (73.19) patients were optimized and operated within 24 hours while 28(28.86%) cases required more resuscitation so tube laparostomy was done initially and operated after 24 hours. Seventy nine (81.44%) cases had single perforation, 14(14.43%) cases had multiple and four had sealed perforation. Primary repair of perforation was done in 37(38.14%) cases, while ileostomy in 65(76.01%) cases. Postoperatively wound infection was seen in 71(73.19%) cases, intra-abdominal collections in 31(31.95%) and burst abdomen in nine (9.27%) cases. Overall mortality was 12.37%. Till date in 47 patients (72.30%) reversal of stoma has been done.Conclusions:Enteric perforation in children presents usually with hemodynamic instability and sepsis due to prolong period of illness. Therefore, regardless of surgical procedure performed it is associated with high morbidity and mortality.
Highlights
Enteric fever remains a health concern in thirdworld and more recently the emergence of drug resistant strains of Salmonella Typhi has challenged diagnostic, and treatment capabilities of existing health system.[1]
IERB 40/2019) medical record was reviewed to identify all cases based upon history of high grade fever for more than one week followed by signs of peritonitis, and per-operative findings of distal ileal perforation at its anti-mesenteric border
High grade fever followed by abdominal pain was the most consistent finding seen in all cases (100%)
Summary
Enteric fever remains a health concern in thirdworld and more recently the emergence of drug resistant strains of Salmonella Typhi has challenged diagnostic, and treatment capabilities of existing health system.[1] Despite global efforts at its eradication it is still prevalent due to lack of access to clean drinking water, unhygienic living conditions and poor health care delivery systems.[2,3] Children are common target of this condition.[4,5] Enteric fever is a medical condition but if left untreated can have a devastating outcome in the form of intestinal perforation.[6] Prolong period of febrile illness. The current study was conducted to evaluate clinical presentation and surgical outcome in children with enteric perforation
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