Typhoid Intestinal Perforation Research Articles

Typhoid intestinal perforation under 5 years of age

Typhoid intestinal perforation is an important cause of morbidity and mortality in many developing countries. The peculiar features in children <5 years old need to be recognised in order to improve outcome. To determine the characteristic pattern and outcome of typhoid intestinal perforation in children under 5 years of age in south-east Nigeria. Comparative analysis of 83 children with typhoid intestinal perforation between January 2001 and December 2006 at the University of Nigeria Teaching Hospital, Enugu. There were 22 (26.5%) children <5 years of age and 61 (73.5%) >5 years. In the younger children, the predominant presentation was fever, vomiting and abdominal tenderness, and in the older children it was fever, abdominal pain and distension. Features of peritonitis were present in only 54.5% aged <5 years compared with 90.2% of the older children (p<0.001). The average number of perforations in the under-5s was 2.1 (range 1-4) and >1.3 (range 1-3) in the older children (p<0.01). The types of operative procedure (simple closure and segmental bowel resection) were similar in both groups. Post-operative complications were not significantly different in the two groups and included surgical wound infection, prolonged ileus, pulmonary infection, wound dehiscence, re-perforation, intra-abdominal abscess and incisional hernia. There were nine (40.9%) deaths in the <5s and 12 (19.7%) in the >5s (p<0.05). Typhoid intestinal perforation in children <5 is associated with atypical presentation and high mortality. A high index of suspicion will ensure earlier presentation and might improve outcome.

Typhoid intestinal perforation in children in Ilorin: Salmonella versus the surgeon: Who is winning the race?

Typhoid intestinal perforation in children in Ilorin: Salmonella versus the surgeon: Who is winning the race?

Typhoid intestinal disease: 32 perforations in 1 patient

Typhoid intestinal perforation is a common complication of typhoid fever in our environment. The occurrence of multiple intestinal perforations that involves both small and large bowel is increasingly being seen in our practice. We report a case of 32 intestinal perforations in a child. This is the highest number of perforations seen in any 1 patient in our search of the English literature. This article details our approach to management of this type of patient.

Typhoid Intestinal Perforations: Twenty-six Year Experience

Typhoid Intestinal Perforations: Twenty-six Year Experience

Typhoid Intestinal Perforations: Twenty‐six Year Experience

Typhoid fever (TF) is a severe febrile illness caused by Salmonella typhi. One of the most lethal complications of TF is ileal perforation (TIP). Although the mortality of associated with TIP has decreased slightly over the past decade, it is still high. The records of the 82 surgically treated patients with TIP were evaluated retrospectively. There were 64 men with the mean age of 36.3 years (range: 7-68 years). In surgical treatment, debridement with primary closure was performed in 32 patients (39.0%), and wedge resection with primary closure was performed in 9 (11. 0%), resection with primary anastomosis in 9 (11.0%), and resection with ileostomy in 32 (39.0%). The most common postoperative complication was wound infection, which occurred in 24 patients (29.3%). The overall morbidity was highest in the ileostomy group. The overall mortality was 11.0% (9 patients). Age, gender, number, and localization of the perforations (p > 0.05) were not found to affect mortality, but prolonged preoperative period (p < 0.001), extended peritoneal contamination (p < 0.01), and ileostomy procedure (p < 0.001) were found to influence the increase in mortality. Early and appropriate surgical intervention with effective preoperative and postoperative care may improve survival in TIP.

Typhoid intestinal perforation in children: a continuing scourge in a developing country

Typhoid intestinal perforation is a principal cause of morbidity and mortality affecting both adults and children. This study aims to evaluate the pattern of typhoid intestinal perforation and outcome of its management in Nigerian children. The records of consecutive children managed for typhoid intestinal perforation at Juth, between 1996 and 2005 have been reviewed. There were 184 children (M:F = 1.04:1), with a mean of 5.8 years (range 4 to 15 years). More than a half (62.5%) of the patients were in the 5-6 year age group. The incidence peaked in April-May, and November-December. Increased incidence of typhoid perforation was observed between 2002 and 2005. All patients presented with the classic features of typhoid enteric perforation. Hypokalaemia and anaemia were common at presentation. Only 75 (40.6%) patients had operation within 24 h of perforation. The types of surgery included simple excision of the edges of the peroration and closure (74.5%), wedge resection and closure in (14.5%), segmental resection with primary end-to-end anastomosis (3.6%) and right hemi-colectomy with ileo-colic or ileo-transverse anastomosis. Wound infection and dehiscence, anastomotic breakdown with faecal fistula, intra peritoneal abscesses and chest infections were the main post operative complications. The overall mortality rate was 22.8 (42). Excision and simple closure was associated with the least incidence of anastomotic breakdown and operation time. The incidence of typhoid intestinal perforation is on the increase at our institution. Early limited surgery provides optimal results.

Typhoid intestinal perforation in sokoto, Nigeria: An unmitigated scourge in the 21st century

Typhoid intestinal perforation in sokoto, Nigeria: An unmitigated scourge in the 21st century

Typhoid intestinal perforation in North Central Nigeria

Typhoid intestinal perforation is a surgical problem with severe morbidity and high mortality in North Central Nigeria. In order to determine the pattern and the prognostic indices, we studied 101 patients with typhoid intestinal perforation managed over a ten-year period Children constituted 49% of the cases and majority (78%) of the patients were in the low socio-economic strata. The incidence peaked to 67% between November and March - the dry season in Nigeria. The male/female ratio was 1.9:1 with a mean age of 19 years and a mean hospitalization period of 18 days. There were 167 perforations; four involved the large bowel and appendix, and in 72.2% cases, the perforation was single. The mortality rate was 13.9%, affected mostly children and significantly worsened by prolonged perforation-surgery interval > 72 hours, jaundice, convulsion, ASA V, faecal peritonitis and re-exploration for early intra-peritoneal complications. Morbidity rate was 65.3% and significantly affected more children than adults and associated with perforation-surgery interval of between 24 and 72 hours, haematochezia and multiple perforations. Moribund patients fared better when operated upon under local anaesthesia with adequate analgesia. The least traumatic but effective surgical procedure that could seal the perforations and keep the peritoneum clean gave the best results. Children who survived up to 5 days and adults who survived up to 10 days after surgery had better chances of survival. The most significant prognostic factor is late presentation which prolongs perforation-surgery interval and the other complication and mortality indices are directly influenced by it.

Tetanus Complicating Typhoid Ileal Perforation: A Case Report

Objective: Both tetanus and typhoid ileitis are endemic in poor developing nations. This presentation aims at contributing to the list of complications of typhoid intestinal perforation. Case Report: A 30-year old male had acute abdomen. Exploratory laparotomy revealed typhoid perforation with faecal contamination of the peritoneal cavity. Post operatively, patient initially improved until the 10th day when he developed tetanus. This resulted in his death 3 days after the onset of spasms. Conclusion: Faecal contamination of the peritoneal cavity is a potential cause of tetanus. The patient was neither immunized nor given adequate and appropriate antibiotics to which Clostridium tetani is sensitive. Ignorance and poverty contributed significantly to this mortality. Tetanus prophylaxis should be a routine component of the management of typhoid intestinal perforation. Key Words: Tetanus, Typhoid ileal perforation, Complication, Faecal contamination Orient Journal of Medicine Vol.16(1) 2004: 8-10

Causes and determinants of outcome of intestinal perforations in a semiurban African community

Background: Intestinal perforations are common causes of generalized peritonitis, it is often severe because of faecal contamination and overwhelming sepsis resulting in high morbidity and mortality. The purpose of the present study was to determine the causes and factors affecting the prognosis in patients with generalized peritonitis as a result of intestinal perforation.Study design: Patients with acute generalized peritonitis from intestinal perforation were prospectively studied during a 6‐year period from 1995 to 2000. Personal, preoperative and postoperative clinical information of all the patients was entered into a predesigned proforma. Data were analysed and the effect of individual causes of peritonitis on the postoperative outcome was determined.Results: More males were affected by a ratio of 3 : 1, with the overall mean age of 27.6 ± 18.3 years (SD). The mean age in patients with typhoid perforation was 21 ± 14 years (SD) and highest in traumatic intestinal perforations (47.2 ± 17.6 years, SD). Typhoid perforation occurred in 75 (58%) patients, acute appendicitis in 21 (16.3%), peptic ulcer disease in 18 (14%), trauma in eight (6.3%), five were idiopathic and one malignant sigmoid carcinoid tumour. Wound infection occurred in 74 (58.3%) and mortality in 24 (18.8%) of the patients. Mortality was high in traumatic and typhoid intestinal perforation than other causes of intestinal perforation. Factors such as age, cause of intestinal perforation, and amount of pus drained during operation independently predicts the postoperative morbidity and mortality rates.Conclusion: Typhoid intestinal perforation was the most common cause of acute generalized peritonitis, followed by perforated acute appendicitis. Prognostic factors include age, the causes of perforation, amount of pus, wound infection, wound dehiscence, faecal fistula, and intra‐abdominal abscess.

Factors effecting morbidity in typhoid intestinal perforation in children.

To determine the factors affecting morbidity in patients with typhoid intestinal perforation (TIP), 42 patients who had been operated upon for TIP between 1990 and 2000 were reviewed. The average age was 10.4 years, the male-to-female ratio 2.5/1. The mean interval from admission to operation was 6 h. Twenty-three children had multiple perforations. Primary closure (PC) was performed in 55% of the patients, ileostomy in 26%, and resection with anastomosis (RA) in 19%. Parenteral nutrition (PN) was available for 22 patients for an average of 9 days. Postoperative complications occurred more commonly in patients with delayed admission and/or severe peritonitis. Hospitalization was shorter and the postoperative complication rate lower in patients who received PN and in those who underwent ileostomy. None of the patients developed an enterocutaneous fistula. The 2 deaths (4.8%) resulted from overwhelming sepsis. The most significant factors affecting morbidity were prolongation of perforation-operation interval and severe peritonitis. No operative procedure is likely to be the best in all cases; therapy should be individualized. Ileostomy appears to be an effective procedure, particularly in patients with severe abdominal contamination and delayed presentation. The use of PN in addition to standard medical and surgical therapy in patients with TIP may be beneficial.

Typhoid intestinal perforations in Nigerian children.

This study was a retrospective analysis of 75 children with perforated typhoid enteritis treated at the Baptist Medical Centre in Ogbomoso, Nigeria over a 4-year period. The mean age was 11.4 years. The usual symptoms were fever and abdominal pain, with a mean duration of 10.5 days. The diagnosis of perforation was usually based on the history and physical examination alone. The time interval from hospital presentation to operation was 11 hours, during which intravenous crystalloid and antibiotics were administered. Among the 75 children, 53 (71%) had a single perforation, and 22 had multiple perforations. Débridement and two-layered closure was performed in 71 (95%) and resection with anastomosis in 4 (5%). Ileus resolution was usually not complete until the eighth postoperative day, and the mean time until the surviving children were afebrile was 10 days. Complications other than death occurred in 7 (9%) children, and there were 15 deaths (20% mortality). All deaths were attributed to overwhelming sepsis, and all but one of the deaths occurred during the first 72 postoperative hours. The only factor statistically significant as a predictor of mortality was the duration of abdominal pain. Improvement in perioperative management including intensive care nursing and more effective antibiotics, although expensive, could result in decreased mortality. A significant decrease in mortality can occur only when the prevention of typhoid fever becomes a higher priority than its treatment.