Prevalence, morbidity, and mortality patterns of typhoid ileal perforation as seen at the University of Nigeria Teaching Hospital Enugu Nigeria: an 8-year review.

Kenneth Agu,Emmanuel Obi,Martin Nzegwu

doi:10.1007/s00268-014-2637-5

Kenneth Agu, Emmanuel Obi + Show 1 more

Open Access

https://doi.org/10.1007/s00268-014-2637-5

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Abstract

BackgroundSome recent studies have reported a decrease in mortality from typhoid ileal perforation. The present report aims to determine the prevalence, morbidity, and mortality of this disease in patients mostly drawn from a rural area.MethodsThis is a retrospective study of 50 patients treated between January 1999 and December 2007 at the University of Nigeria Teaching Hospital, Enugu, Nigeria. The variables studied included patient demographics, clinical features, intraoperative findings, complications, and mortality. Statistical analysis was done with SPSS version 13.ResultsOf the 50 patients included in the study, 22 were males with the highest rate in patients aged 20 years and younger. Fever was the commonest symptom and at initial presentation, the mean pulse and respiratory rates were significantly higher in the patients who subsequently died than in those who survived (P < 0.05). All the perforations occurred in the ileum; 62 % of the patients had solitary perforations, 28 % had double perforations, and 10 % had three or more. Fifty-eight perforations were treated by simple closure in two layers, 4 patients had ileal resection and anastomosis, and 2 underwent right hemicolectomy. The mean interval between operation and death was 1.7 days. The overall mortality rate was 30 %, but among those with three or more perforations, mortality was 100 %.ConclusionsTyphoid ileal perforation still carries a high mortality especially in rural areas. Those with tachycardia and tachypnea at presentation and those with three or more perforations are at a higher risk of dying from the disease.

Highlights

Typhoid fever or enteric fever is a severe infective disease that is endemic in many developing countries [1,2,3]
Typhoid fever and its life-threatening complication ileal perforation is prevalent in our environment as in many developing countries with a lack of safe drinking water and adequate sewage disposal [1,2,3]
We did not record any case of relative bradycardia in our patients

Summary

Introduction

Typhoid fever or enteric fever (comprising typhoid and paratyphoid fevers) is a severe infective disease that is endemic in many developing countries [1,2,3]. Transmission is by the feco-oral route from contamination of food, water, and other drinks by waste from infected patients or carriers. Perforation of the ileum is the commonest life-threatening complication of typhoid fever [1,2,3,4,5]. The illness manifests with various degrees of severity determined by the virulence of the organism and the host’s immunity, among other factors. Some recent studies have reported a decrease in mortality from typhoid ileal perforation. The present report aims to determine the prevalence, morbidity, and mortality of this disease in patients mostly drawn from a rural area

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Results

Conclusion