Predictor of mortality in children with typhoid intestinal perforation in a Tertiary Hospital in Nigeria

Abstract

Typhoid intestinal perforation (TIP) exerts a great toll both on the patients and the surgeons in resource poor countries. Factors that predict mortality in patients with TIP remain controversial. The study aims to determine factors that predict mortality in a Nigerian tertiary facility and to offer strategies for improvement. We conducted a retrospective analysis of data of 153 children who underwent surgery for TIP at a Tertiary Hospital in Nigeria over a period of 8years (January 2002 to December 2009). Data collected included patient demographics, presentation, haemoglobin level (Hgb), presentation-operation interval, type of surgical procedure, nature of peritoneal collection, the number of perforations and duration of surgery. Postoperative complications, duration of hospital stay and outcome were also examined. There were 99 (64.7%) boys and 54 (35.3%) girls aged 3-15years, mean (SD)=9.4 (±3.6) years. There were 105 single perforations and 46 multiple perforations (range 1-32). The surgical procedure was simple 2-layer closure in 128 (83.7%) and segmental resection in 9 (5.9%) children. The mortality was 16 (10.4%). The mean (SD) age of children who survived and those who died was 9.3 (±3.6) years and 10.1 (±4.0) years, respectively; p=0.446, the mean duration of symptom in children who survived and those who died was 10.3 (±4.9) days and 12.3 (±5.6) days; p=0.164, and the mean interval between presentation and operation in those who died and those who survived was 29.3 (±25) h and 28.4 (±13.4) h; p=0.896. Temperature ≥38.5°C (p=0.040), anastomotic leak (p=0.029) and faecal fistula (p=0.000) were significantly associated with mortality. Age <5years (p=0.675), male gender (p=0.845), presentation-operation interval ≥24h (p=0.940), Hgb less than 8g/dL (p=0.058), faeculent peritoneal collection (p=0.757), number of perforations (p=0.518) and the surgical technique (p=0.375) were not related to mortality. Logistic regression analysis showed that only postoperative faecal fistula (p=0.001; OR=13.7) independently predicted mortality. Development of postoperative fecal fistula significantly predicted mortality. Prioritizing the prevention of typhoid fever than its treatment and attention to surgical details may significantly reduce mortality of TIP in children in this setting.