Typhoid Intestinal Perforation Research Articles

Typhoid intestinal perforation in Francophone Africa, a scoping review.

Typhoid intestinal perforation (TIP) is a leading cause of peritonitis and indication for emergency surgery in Africa, with reported mortality rates up to 30% in pediatric patients. Currently, data on TIP in Western databases are primarily from countries that speak English, likely due to non-English publication and citation biases. Despite the high burden of infectious diseases in Francophone Africa, data from these countries regarding TIP remain limited. This study aims to highlight the incidence and morbidity of TIP in Francophone African countries using an extended search algorithm. We conducted a scoping review using the PubMed, EMBASE, and SCOPUS databases with the keywords "peritonitis", "non-traumatic ileal perforation", and "typhoid" in Francophone African countries. Additionally, we contacted surgeons in Africa and concurrently used citation chasing to obtain data not found in western databases. In total, 32 studies from 12 countries were identified and included in this review. A total of 22 publications were in French. Patient median age was 20 years and TIP caused a median of 35% of acute peritonitis cases. Mortality rates ranged from 6-37% (median: 16%). Rate of complications ranged from 15-92% (median: 46%). Ileostomy creation as a treatment for TIP varied between hospitals (0-79%), with the highest rates reported in Niger. In Francophone Africa, TIP is associated with high morbidity and mortality, most commonly in children and young adults. Interventions, including improved sanitation and the introduction of typhoid conjugate vaccines into routine vaccination programs, have the potential to significantly decrease typhoid fever and its complications.

Comparison of the Efficacy of Haematoxylin & Eosin (H&E) and Periodic Acid Schiff (PAS) Staining Techniques in the Diagnosis of Typhoid Intestinal Perforation (TIP) among Patients Attending Federal Medical Centre, Keffi Nasarawa State, Nigeria

Aim of the Study: To compare the efficacy of H&E and PAS staining techniques in the demonstration of TIP among patients attending Federal Medical Centre Keffi, Nasarawa state. Study Design: The study is a retrospective study, a total of 129 paraffin-embedded tissue blocks of patients who were diagnosed of TIP between January 1st 2013 and December 31st 2022 were retrieved from the archives of Histopathology laboratory and examined. Ten patients (10) with incomplete data were excluded.
 Methodology: A semi structured questionnaire was used to collect demographic data. The tissue blocks were sectioned at 4um and stained using Haematoxylin and Eosin (H&E) staining technique and Periodic Acid Schiff (PAS) technique. The microscopic examination was done using x10 and x40 objectives of the Olympus light microscope.
 Results: The study showed that males were more affected with TIP than females with ratio 1.6: 1. Ages of patients ranged between 6 months-77 years with mean age of 24.8+1.87 years. The highest number of TIP cases was recorded in December. The ileal segment was the most perforated among the intestinal segments. The socioeconomic status of patients, availability of potable water supply as well as hygiene and sanitary practices were discovered to be key factors in typhoid fever infection and treatment outcomes.
 Conclusion: Although, both PAS and H&E staining techniques showed favorable features, the PAS technique gave better contrast and also revealed the perforation sites better than H&E at P<0.001. Hence, the PAS technique should be done alongside the H&E in the laboratory investigation of intestinal tissues.

Outcome of Typhoid Intestinal Perforation Management in a Tertiary Hospital, North-Central Nigeria

Background: Typhoid intestinal perforation is the most common surgical complication and a significant cause of morbidity and mortality in typhoid fever.
 Aim: To determine the treatment outcome of patients with typhoid intestinal perforation.
 Methods: A single-centre retrospective study involving retrieving case notes of all consecutive patients who had surgeries for peritonitis secondary to typhoid intestinal perforation from October 2016 to September 2017. Data were collected with a designed case report form and analysed.
 Results: Sixty-nine patients had surgeries for typhoid intestinal perforation, of which forty-five (65.2%) were males. The median (range) age of the participants was 10(4-44) years. The commonest complications were surgical site infections 49 (71%) and wound dehiscence 17 (24.6%). The median (range) post-operative hospital stay among the survivors was 13 (7 – 50) days. Enterocutaneous fistula and wound dehiscence were responsible for prolonged hospital stay (x2= 30.126, p value< 0.001 and x2= 45.777, p value< 0.001 respectively). The overall mortality rate was 19 (27.5%). Under-five children had the highest mortality rate 5/15 (33.3%). Mortality was found to be more common among females though the association was not statistically significant (p value = 0.052). Mortality was significantly associated with extended surgical procedures (p value= 0.027). 
 Conclusion: The reported cases of typhoid intestinal perforations at the study centre were high but the mortality rate was comparable to other similar studies in Nigeria. Mortality from typhoid perforation remains high, and the pathology is best prevented

Characterization of Typhoid Intestinal Perforation in Africa: Results From the Severe Typhoid Fever Surveillance in Africa Program.

Typhoid intestinal perforation (TIP) remains the most serious complication of typhoid fever. In many countries, the diagnosis of TIP relies on intraoperative identification, as blood culture and pathology capacity remain limited. As a result, many cases of TIP may not be reported as typhoid. This study demonstrates the burden of TIP in sites in Burkina Faso, Democratic Republic of Congo (DRC), Ethiopia, Ghana, Madagascar, and Nigeria. Patients with clinical suspicion of nontraumatic intestinal perforation were enrolled and demographic details, clinical findings, surgical records, blood cultures, tissue biopsies, and peritoneal fluid were collected. Participants were then classified as having confirmed TIP, probable TIP, possible TIP, or clinical intestinal perforation based on surgical descriptions and cultures. A total of 608 participants were investigated for nontraumatic intestinal perforation; 214 (35%) participants had surgically-confirmed TIP and 33 participants (5%) had culture-confirmed typhoid. The overall proportion of blood or surgical site Salmonella enterica subspecies enterica serovar Typhi positivity in surgically verified TIP cases was 10.3%. TIP was high in children aged 5-14 years in DRC, Ghana, and Nigeria. We provide evidence for correlation between monthly case counts of S. Typhi and the occurrence of intestinal perforation. Low S. Typhi culture positivity rates, as well as a lack of blood and tissue culture capability in many regions where typhoid remains endemic, significantly underestimate the true burden of typhoid fever. The occurrence of TIP may indicate underlying typhoid burden, particularly in countries with limited culture capability.

Resolution of Free Air in the Peritoneal cavity after Laparotomy for Bowel Perforation in Children: How Long Does It Take?

Background: Preoperatively, the presence of free air in the peritoneal cavity (pneumoperitoneum) is indicative of a gastrointestinal perforation and laparotomy exposes the peritoneal cavity and bowel to atmospheric air. The aim of this study was to evaluate how long (in days) it takes for free air in the peritoneal cavity to disappear following laparotomy in children. Materials and Methods: This was a prospective study of children aged 15 years and younger who had laparotomy for bowel perforation at the pediatric surgery unit of a teaching hospital in Enugu, Nigeria. This study covered a 5-year period. The patients were followed up postoperatively to evaluate which day post op the free air in the peritoneal cavity resolves. Results: A total of 112 cases of perforated bowel had laparotomy during the study period. Amongst this number, 37 (33%) patients showed pneumoperitoneum on their preoperative radiographs and form the basis of this report. There was male predominance. Abdominal pain is a consistent symptom in all the patients. Majority of the patients had typhoid intestinal perforation with single ileal perforation and primary intestinal repair was the most performed procedure. Wound infection was the most common post-operative complication and the general outcome was fair. Overall, the mean time for the pneumoperitoneum to disappear was 5.5 days postoperatively. Conclusion: Bowel perforation results mostly from infective/inflammatory processes such as typhoid intestinal perforation. Laparotomy is required for the repair of these perforations and its takes an average of 5.5 days for the free peritoneal air to resolve.

Pediatric Stomas: A Study in a Teaching Hospital, Our Experience

Background: A stoma is a purposeful surgical connection of a segment of a hollow viscus (intestine, ureter) to the anterior abdominal wall and can be a life-saving procedure. The aim of this study was to evaluate our experience in respect of stomas (ileostomies, colostomies, ureterostomies) performed in children. Materials and Methods: This was a retrospective study of children who had stoma created at the pediatric surgery unit of a teaching hospital in Enugu, Nigeria. Children who had intestinal or urinary tract stomas were included in the study and covered a 10-year period. The information analyzed included the patients’ age, gender, diagnosis, indications for the stoma creation, type of stoma (colostomy, ileostomy and ureterostomy), post-operative complications and treatment outcome. Results: A total of 112 stomas were created in children during the 10-year study period. There were 80 (71.4%) males and 32 (28.6%) females. Hirschsprung’s disease and typhoid intestinal perforation were the first and second most common indications for stoma creation. Colostomy creation and peristomal skin excoriations were the most performed stoma and most common post-operative complication respectively. Eleven (9.8%) patients expired due to respiratory failure and uncontrollable sepsis. Conclusion: Stoma creation may form an essential component for the treatment of surgical conditions in children and it can be life-saving. Stomas can be created for disorders of the intestinal and urinary tracts. There may be stoma complications accounting for morbidity experienced in these patients.

Typhoid Intestinal Perforation Prognostic Score in Poor-Resource Settings.

Mortality from peritonitis due to typhoid intestinal perforation (TIP) in sub-Saharan Africa is high. This study aimed to determine the predictive factors of mortality, propose a prognostic score, and determine the appropriate surgical treatment for TIP in low-resource settings. This was a retrospective data collection of peritonitis due to TIP admitted at Zinder National Hospital from 2014 to 2021. To build a typhoid intestinal perforation prognostic score (TIPPS), patients were randomised into two groups: a score-building group and a validation group. Univariate and multivariate analyses were performed to identify risk factors of mortality. The value of P <0.05 was assigned significant for all analyses. TIP accounted for 52.4% (n = 1132) of all cases of peritonitis (n = 2159). The median age was 12 years. Rural provenance represented 72.2% (n = 817). Deaths accounted for 10.5% (n = 119). The factors influencing mortality were respiratory rate ≥24/min (odds ratio [OR] = 2.6, P = 0.000), systolic blood pressure <90 mmHg (OR = 0.31, P = 0.002), serum creatinine >20 mg/L (OR = 2.6, P ≤ 0.009), haemoglobin (OR = 2.1, P = 0.000), comorbidity (OR = 3.5, P = 0.001), the American Society of Anesthesiologists score IV&V (OR = 3.3, P = 0.000), admission and management delay > 72 h (OR = 3.2, P = 0.001), and a number of perforations (OR = 2.4, P = 0.0001). These factors were used to build a "TIPPS" score, which ranged from 8 to 20. The risk of mortality was associated with increased TIPPS. The performance of this score was good in the two groups (area under receiver operating characteristic > 0.83). According to the severity and mortality risk of TIP, we classified TIPS into four grades: grade I (low risk: 8-10), grade II (moderate risk: 11-13), grade III (high risk: 14-16) and grade IV (very high risk: 17-20). The TIPPS is simple. It can describe the severity of the disease and can predict the risk of death. The study highlights the importance and impact of timely and adequate perioperative resuscitation in more complicated cases.

Postpartum Typhoid Intestinal Perforation

Background: Typhoid fever remains a highly contagious and multi-systemic infection caused by salmonellae typhi, and like other gastro-enteric infection, it poses a higher risk of morbidity and mortality during pregnancy as a result of the physiological changes associated with pregnancy as well as concerns of antibiotic safety in pregnancy. The occurrence of typhoid perforation in pregnancy may be easily confused for other causes of acute abdomen in pregnancy.&#x0D; We report the presentation, management and outcome of a 25 year old postpartum woman who presented with typhoid intestinal perforation in a resource limited environment. She had an emergency exploratory laparotomy and was managed post operatively in the ICU but clinically deteriorated and subsequently died on the third post-operative day secondary to multiple organ failure from severe sepsis.&#x0D; Typhoid perforation in pregnancy is a rare presentation, a high index of suspicion, and early intervention, would reduce the incidence of morbidity and mortality associated with this disease condition.

Post-operative Complications following Laparotomy for Typhoid Intestinal Perforation in Children: Experience in a Tertiary Hospital in Enugu, Nigeria

Post-operative Complications following Laparotomy for Typhoid Intestinal Perforation in Children: Experience in a Tertiary Hospital in Enugu, Nigeria

Closure of Abdominal Incisions Following Laparotomy for Peritonitis in Children: Primary Closure or Delayed Primary Closure?

Background: There is need to determine the optimal management strategy for dirty abdominal surgical wounds. The aim of this study was to evaluate the post-operative wound complications in children whose dirty surgical wounds were closed primarily, in relation to those closed by delayed primary closure. Materials and Methods: This was a prospective evaluation of children, aged 15 years and younger, who had laparotomy for peritonitis in a teaching hospital in Enugu, Nigeria. This study covered a 5-year period. The following data were evaluated: patients’ age, gender, presenting symptoms, laboratory results at presentation, duration of symptoms before presentation, time interval between presentation and intervention, intra-operative finding, definitive operative procedure performed, complications of treatment, and outcome of treatment of the 2 groups of patients. Results: A total of 204 cases of peritonitis in children were operated upon during the study period. The incisions were closed by primary closure (Group A) in 104 (51%) while 100 (49%) surgical wounds were closed by delayed primary closure (Group B). More males were involved. All the patients had abdominal pain and about half the patients were anemic and had electrolyte imbalance at presentation. Typhoid intestinal perforation was the most common cause of peritonitis and closure of ileal perforation was the most frequent performed surgical procedure. Comparing the 2 groups of patients, surgical site infection and stitch related were less common in group B patients whose surgical incisions were closed by delayed primary closure. Conclusion: Delayed primary closure of dirty laparotomy incisions has less complication in terms of surgical site infection and stitch related complications. Therefore, delayed primary closure of dirty laparotomy wounds is advocated in pediatric population.

Surge of Typhoid Intestinal Perforations as Possible Result of COVID-19–Associated Delays in Seeking Care, Madagascar

During the coronavirus disease pandemic, we observed a 6.4-fold increase in typhoid intestinal perforation incidence in Antananarivo, Madagascar. Thirteen perforations occurred within 6 months (February 2020–July 2020), compared with 13 perforations during the previous 41 months (August 2016–January 2020). The increase may be attributable to delayed healthcare seeking during the pandemic.

Complications and mortality of typhoid fever: A global systematic review and meta-analysis

Updated estimates of the prevalence of complications and case fatality ratio (CFR) among typhoid fever patients are needed to understand disease burden. Articles published in PubMed and Web of Science from 1 January 1980 through 29 January 2020 were systematically reviewed for hospital or community-based non-surgical studies that used cultures of normally sterile sites, and hospital surgical studies of typhoid intestinal perforation (TIP) with intra- or post-operative findings suggestive of typhoid. Prevalence of 21 pre-selected recognized complications of typhoid fever, crude and median (interquartile range) CFR, and pooled CFR estimates using a random effects meta-analysis were calculated. Of 113 study sites, 106 (93.8%) were located in Asia and Africa, and 84 (74.3%) were non-surgical. Among non-surgical studies, 70 (83.3%) were hospital-based. Of 10,355 confirmed typhoid patients, 2,719 (26.3%) had complications. The pooled CFR estimate among non-surgical patients was 0.9% for the Asia region and 5.4% for the Africa region. Delay in care was significantly correlated with increased CFR in Asia (r = 0.84; p<0.01). Among surgical studies, the median CFR of TIP was 15.5% (6.7-24.1%) per study. Our findings identify considerable typhoid-associated illness and death that could be averted with prevention measures, including typhoid conjugate vaccine introduction.

Profile of Abdominal Surgical Complications of Enteric Fever in Children in a Developing Country

Background: Surgical complications of enteric fever has been associated with significant morbidity and mortality. The aim of this study was to determine the pattern and outcome of the treatment of abdominal surgical complications of enteric fever in children in a teaching hospital in Enugu, Nigeria.&#x0D; Methods: This retrospective study included children who had undergone a surgery for abdominal complications of enteric fever at the pediatric surgery unit of Enugu State University Teaching Hospital (ESUTH), Enugu, Nigeria. The medical records of the pediatric patients over a five-year period were evaluated for the patients’ demographics, presenting symptoms, investigations, intraoperative findings, procedures performed, and postoperative complications and outcome.&#x0D; Results: During the study period, there were 44 cases of abdominal surgical complications of enteric fever with an age range of 6–14 years (mean 9.5 years) and the male to female ratio of 2.7:1. The mean duration of symptoms prior to presentation was five days. All the patients had fever and abdominal pain. While 95% of the patient had typhoid intestinal perforation, 5% had typhoid hemorrhage. Primary closure of intestinal perforation and right hemicolectomy with ileotransverse anastomosis were performed for typhoid intestinal perforation and typhoid intestinal hemorrhage, respectively. Surgical site infection was the most common postoperative complication. The mortality rate was 6.8%.&#x0D; Conclusion: Abdominal surgical complications of enteric fever are still obtainable in developing countries. Typhoid intestinal perforation was the most common complication recorded in the present study.&#x0D; Keywords: abdominal, children, enteric fever, surgical complications

Peritonitis in Children: Experience in a Tertiary Hospital in Enugu, Nigeria

Background: Peritonitis may be associated with significant morbidity and mortality. The aim of this study was to evaluate our experience with the management of secondary peritonitis in children. Methods: This was a retrospective study of children who had undergone laparotomy for peritonitis in the pediatric surgery unit of Enugu State University Teaching Hospital (ESUTH) in Enugu, Nigeria over a five-year period. Results: There were 52 cases of laparotomies for peritonitis, with an age range of two weeks to 14 years (median: nine years) and a male to female ratio of 3.3:1. The etiologies of peritonitis were typhoid intestinal perforation in 25 cases (48%), ruptured appendix in nine cases (17.3%), perforated intussusception in eight cases (15.4%), perforated external hernia in three cases (5.8%), perforation due to adhesive intestinal obstruction in three cases (5.8%), perforated necrotizing enterocolitis in three cases (5.8%), and bowel perforation due to trauma in one case (1.9%). The following definitive surgical procedures were performed: closure of bowel perforation in 26 cases (50%), appendectomy plus abscess drainage in nine cases (17.3%), right hemicolectomy with ileotransverse anastomosis in eight cases (15.4%), segmental bowel resection in six cases (11.5%), and insertion of peritoneal drains in three cases (5.8%). The median duration of symptoms prior to presentation and the median duration from presentation to surgery were four days and two days, respectively. Twenty-four patients (46.2%) developed complications that included surgical site infection in 12 cases (23.1%), enterocutanous fistula in five cases (9.6%), intra-abdominal abscess in four cases (7.7%), and wound dehiscence in three cases (5.8%). There were seven deaths, accounting for 13.5% of the patients. Conclusion: Typhoid intestinal perforation was the most common cause of peritonitis in the present study. Keywords: Children; peritonitis; developing country; single center

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

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

Burden of Complicated Intra-Abdominal Infections in Children in Nigeria: Recent Experience and Systematic Review.

Background: Intra-abdominal infections encompass a wide range of conditions from uncomplicated appendicitis to fecal peritonitis. Little is known about the burden of complicated intra-abdominal infection (cIAIs) in children in low- and middle-income countries (LMICs). Method: This a report of recent experience and a systematic review of the burden in Nigeria. Results: Of 85 children with cIAIs, the most common primary cause was typhoid intestinal perforation (54; 63.5%) and complicated appendicitis (20; 23.5%). The complication rate after surgery was high, including surgical site infection (SSI) in 49 (57.6%), post-operative intra-abdominal abscess in 14 (16.5%), and complete abdominal wound dehiscence in 13 (15.3%). The rate of re-operation was 19 (22.4%) and 12 (14.1%) patients required re-admission for adhesion intestinal obstruction and unresolved SSI. Eight (9.4%) died from overwhelming infection. Systematic review revealed only a few publications, but these were mostly on specific causes of cIAIs and publications providing comprehensive data are lacking. Conclusion: Investment in research into cIAIs in children in LMICs is needed. Efforts need to be focused on the role of source control in reducing the high complication rate and mortality.

Morbidity and Mortality of Typhoid Intestinal Perforation Among Children in Sub-Saharan Africa 1995\u20132019: A Scoping Review

BackgroundTyphoid fever incidence and complications, including intestinal perforation, have declined significantly in high-income countries, with mortality rates <1%. However, an estimated 10.9 million cases still occur annually, most in low- and middle-income countries. With the availability of a new typhoid conjugate vaccine licensed for children and recommended by the World Health Organization, understanding severe complications, including associated mortality rates, is essential to inform country-level decisions on introduction of this vaccine. This scoping review summarizes over 20 years of the literature on typhoid intestinal perforation in sub-Saharan Africa.MethodsWe searched EMBASE, PubMed, Medline, and Cochrane databases for studies reporting mortality rates due to typhoid intestinal perforation in children, under 18 years old, in sub-Saharan Africa published from January 1995 through June 2019.ResultsTwenty-four papers from six countries were included. Reported mortality rates ranged from 4.6–75%, with 16 of the 24 studies between 11 and 30%. Thirteen papers included postoperative morbidity rates, ranging from 16–100%. The most documented complications included surgical site infections, intra-abdominal abscesses, and enterocutaneous fistulas. High mortality rates can be attributed to late presentation to tertiary centers, sepsis and electrolyte abnormalities requiring preoperative resuscitation, prolonged perforation-to-surgery interval, and lack of access to critical care or an intensive care unit postoperatively.ConclusionsCurrent estimates of mortality related to typhoid intestinal perforation among children in sub-Saharan Africa remain unacceptably high. Prevention of typhoid fever is essential to reduce mortality, with the ultimate goal of a comprehensive approach that utilizes vaccination, improvements in water, sanitation, and hygiene, and greater access to surgical care.

Catastrophic Healthcare Expenditure from Typhoid Perforation in Children in Nigeria.

Background: Out-of-pocket payments and catastrophic healthcare expenditures (CHE) are important barriers to achieving equity and access to emergency and essential surgical care in low- and middle-income countries (LMICs), with important implications for universal health coverage (UHC). However, data on CHE for surgical care in these settings are limited, especially with regard to infections. Methods: We performed a retrospective review of 32 children receiving laparotomy for typhoid intestinal perforation in a four-year period. Data on medical costs were reviewed. Because of the lack of reliable data on household incomes and average national incomes for Nigeria, gross domestic product per capita was used to calculate CHE. The GDP per capita for the country during the study period was $2,028.182. Expenditure >10% GDP per capita (or > $202.82) was considered CHE. Results: There were 15 boys and 17 girls aged 2-15 years (mean 7.72 years). Seventeen patients (53%) were referred from district/general hospitals or mission hospitals. After surgical treatment, 16 patients (50%) developed complications (intra-abdominal abscesses and incision complications), and nine (28.1%) required re-operation. Seven patients (21.9%) required intensive care (ICU) treatment and three (9.4%) died from overwhelming infection. The hospital stay was 3-93 days (mean 23 days). The average total medical cost was $452 (range $236-$1,700). The total medical costs exceeded 10% of GDP ($202.82) for all patients. Total expenditure for four patients requiring intensive care exceeded $202.82 for the ICU care alone. Conclusion: Surgical treatment of typhoid intestinal perforation in children is associated with a high rate of CHE if care is provided at tertiary hospitals. Investments in prevention and control of this and other surgical infections as well as scale up of capacity at district hospitals to provide such care are important in preventing CHE.

Enterostomies for acute abdominal surgical condition in children: An experience in a developing country

Background: Pediatric abdominal surgical condition that is complicated by gross peritoneal contamination may require enterostomy as a damage control or salvage procedure. Late presentations mostly seen in developing countries make creation of enterostomy a relatively common surgical procedure. The aim of this study was to evaluate the creation of enterostomy in children who presented with acute abdominal surgical conditions. Methods: This was a retrospective study of children that had enterostomy in the pediatric surgery unit of Enugu State University Teaching Hospital, Enugu, Nigeria. Medical records of pediatric patients that had enterostomy over a 10-year period were assessed. Results: There were 32 cases of enterostomies performed during the study period. There were 25 males (78.1%) and 7 females (21.9%) with a male to female ratio of 3.6:1. The age range of the patients was 3 weeks to 180 months, with a median age of 96 months. There were 1 neonate (3.1%), 10 infants (31.3%) and 21 children (65.6%) older than 1 year. The primary diagnoses were typhoid intestinal perforation in 21 patients (65.6%), intussusception 10 (31.3%) and intestinal atresia 1 (3.1%). Ileostomy was performed in 31 patients (96.9%) and jejunostomy in 1 patient (3.1%). Enterostomy was created at the time of initial laparotomy (damage control) in 21 patients (65.6%) while 11 patients (34.4%) had their enterostomy as a salvage procedure at the time of re-exploration. Peristomal skin complication was the most common complication recorded in our patients. Mortality was 12.5%. Conclusion: Enterostomy is lifesaving in the management of acute abdominal surgical condition when there is gross peritoneal contamination in severely ill children. Proper surgical technique and electrolyte derangements are important considerations when enterostomies are created.

Intestinal Resection in Children: Our Experience in Enugu, Nigeria

Background: Intestinal resection in children is an important surgical procedure because of the possible complications that may arise from it. Late presentation and ignorance in developing countries have made intestinal resection a frequent surgical procedure. Methods: This was a retrospective study of children that had intestinal resection in the pediatric surgery unit of Enugu State University Teaching Hospital, Enugu, Nigeria. The medical records of the pediatric patients that underwent intestinal resection over a 10-year period were evaluated for the indications that prompted the surgery. The other parameters that were assessed included the patients’ demographics, the duration of symptoms before presentation, the time interval between presentation and intervention, the complications arising from the intestinal resection, and the outcome. Results: There were 52 cases of intestinal resection with an age range of 1–168 months (median 10 months) and a male to female ratio of 2.25:1. There were 9 neonates (less than one month of age), 29 infants (greater than one month but less than one year of age) and 14 children (older than 1 year of age). The following were the indications for intestinal resection: gangrenous/irreducible intussusception (28 or 53.8%), strangulated external hernia (7 or 13.5%), typhoid intestinal perforation (6 or 11.5%), intestinal atresia (3 or 5.8%), gastroschisis (3 or 5.8%), midgut volvulus (3 or 5.8%), and abdominal trauma (2 or 3.8%). The following definitive surgical procedures were performed: right hemicolectomy with ileotransverse anastomosis (28 or 53.8%), segmental resection with end-to-end anastomosis (20 or 38.5%), and massive intestinal resection with end-to-end anastomosis (4 or 7.7%). The median duration of symptoms prior to presentation and the median duration from presentation to surgery were 3 days and 2 days, respectively. The mean duration of hospital stay was 15 days. Twenty patients (38.4%) developed complications, which included surgical site infection (8 or 15.4%), enterocutanous fistula (6 or 11.5%), intra-peritoneal abscess (4 or 7.7%), and adhesive intestinal obstruction (2 or 3.8%). There were 8 deaths, which accounted for 15.4% of the patients. Conclusion: Intestinal resection was performed most often for intussusception. Late presentation and ignorance contributed significantly to the number of intestinal resections required. Keywords: Children; intestinal resection; experience; intussusception; hernia