Typhoid ileal perforation: analysis of morbidity and mortality in 89 children.
BACKGROUND
Typhoid ileal perforation is still prevalent in many developing countries. Despite the advances in the management, the outcome in children is still very poor.


OBJECTIVE
To determine the morbidity and mortality of childhood typhoid ileal perforation in a tertiary referral centre in southeast Nigeria.


METHODS
Retrospective evaluation of 89 children operated for typhoid ileal perforation over a 10-year period (January 1, 1995 through December 31, 2004) at the University of Nigeria Teaching Hospital, Enugu.


RESULTS
There were 54 (60.7%) boys and 35 (39.3%) girls aged 1 15 years (mean 9.1 years). Thirty-nine (43.8%) were > 10 years. Fever and generalized abdominal pain were the predominant symptoms for 5 21 days (mean 13.4 days) and 2 13 days (mean 8.8 days) respectively before presentation; Seventeen (89.5%) of those < 5 years had vomiting. Pneumoperitoneum was demonstrated radiologically in 59 (66.3%) children. Surgical treatment involved simple closure in 46 (51.7%) children and segmental intestinal resection in 43 (48.3%). Surgical site infection 41 (46.1%), chest infection 21 (23.6%) and reperforation 19 (21.3%) were the commonest postoperative complications. The overall mortality was 17 (19.1%) from overwhelming infection. Age < 5 years and prolongation of perforation-operation interval worsened morbidity and mortality.


CONCLUSIONS
Typhoid ileal perforation in childhood is associated with high morbidity and mortality. Outcome can be improved by early presentation and intervention.
Ekenze
S O
SO
Department of Pediatric Surgery, University of Nigeria Teaching Hospital, Enugu. soekenze@yahoo.com
Okoro
P E
PE
Amah
C C
CC
Ezike
H A
HA
Ikefuna
A N
AN
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007077:Ileal Diseases / Q000453:epidemiology* / Q000209:etiology*; D007223:Infant; D007416:Intestinal Perforation / Q000453:epidemiology* / Q000209:etiology*; D008297:Male; D009017:Morbidity / Q000639:trends; D009549:Nigeria / Q000453:epidemiology; D012189:Retrospective Studies; D012422:Rupture, Spontaneous; D015996:Survival Rate / Q000639:trends; D014435:Typhoid Fever / Q000150:complications* / Q000453:epidemiology