Fifteen years of typhoid perforation in children in Ibadan: still a millstone around the surgeon's neck

Abstract

Objective: To study the disease of typhoid in children over a significant period of time, in this case, 15 years to see whether there have been any changes in presentation, mode of treatment, morbidity and mortality rates. Method: A retrospective study of 183 children operated on for typhoid ileal perforation in 15 years. Results: All the patients were resuscitated with intravenous infusion of normal saline, nasogastric tube decompression, correction of deranged electrolytes. Antibiotic treatment with intravenous chloramphenicol and metronidazole with or without gentamycin prior to 1996 and intravenous ofloxacin (ciprofloxacin or perfloxacin) with metronidazole from 1996 till date. All patients had exploratory laparotomy under general anaesthesia and endotracheal intubation with closure of the perforation in 2 layers for most of the patients and ileal resection with end –to- end anastomosis or right hemicolectomy in a few patients. Conclusion: Incidence rates at 5-yearly intervals seem to be decreasing and mortality rates seem to be increasing. Complications seem to remain unchanged inspite of different surgical techniques and newer anti-salmonella drugs. Key Words: Typhoid perforation, children, morbidity, mortality Nigerian Journal of Surgical Research Vol.5(1&2) 2003: 92-99