Related Experiment Videos
Typhoid ileal perforation in children: a scourge in developing countries
1Department of Surgery, Ahmadu Bello University Teaching Hospital, Zaria, Nigeria. ameh@abu.edu.ng
Insights
Typhoid perforation significantly impacts children under 12, with higher risks in older children. Early presentation is crucial for survival, as late diagnosis leads to high mortality from sepsis.
Area of Science:
- Pediatric Surgery
- Infectious Diseases
- Public Health
Background:
- Typhoid perforation is a severe complication of Salmonella Typhi infection.
- It disproportionately affects children in developing countries.
- Understanding epidemiological and clinical features is vital for management.
Purpose of the Study:
- To analyze the incidence, clinical presentation, and outcomes of typhoid perforation in children.
- To identify risk factors associated with mortality.
- To inform public health strategies for prevention and early intervention.
Main Methods:
- Retrospective analysis of 64 pediatric cases of typhoid perforation over 10 years.
- Data collection on demographics, clinical features, seasonality, treatment, and outcomes.
- Statistical analysis to determine factors influencing mortality.
Main Results:
- Children under 12 accounted for 56% of typhoid perforations.
- Perforation rates increased with age, peaking in the 10-12 year group (29.3%).
- Common symptoms included fever and abdominal pain; 20.3% had associated hemorrhage. High morbidity (53%) and mortality (39%) were observed, with sepsis being a major cause of death. Late presentation (>7 days) significantly correlated with increased mortality (p < 0.05).
Conclusions:
- Typhoid perforation remains a critical health issue in pediatric populations in resource-limited settings.
- Improved sanitation, safe water, and public awareness are essential for prevention and early detection.
- Timely medical intervention is crucial to reduce the high morbidity and mortality rates.
Abstract:
Over a 10-year period, 64 children aged < or = 12 years were treated for typhoid perforation, accounting for 56% of all cases of typhoid perforation at our institution. The perforation rates in the age groups < 1, 1-4, 5-9 and 10-12 years were 4%, 1.7%, 12.4% and 29.3%, respectively, with an overall perforation rate of 10.3%. The main features were fever (93.4%) and abdominal pain and tenderness (93.4%). Thirteen children (20.3%) had associated haemorrhage, presenting as haematochezia. The incidence of perforations was 52% during the rainy season and 48% during the dry season, but the disease occurred throughout the year with a peak in October, the beginning of the dry season, which was also the time of peak occurrence of typhoid without perforation. An average of 14 h (range 5-30) was required for resuscitation. Ketamine was used for anaesthesia in most cases. Treatment was by segmental resection (67%), wedge excision (17%) and simple closure (6%). Morbidity was high (53%), and wound infection (53%) and chest infection (30%) were the most common complications. There were 25 deaths (39%), most the result of overwhelming sepsis. Late presentation at > 7 days was associated with high mortality (p < 0.05). Typhoid perforation continues to be a scourge in children in developing countries and, in addition to preventive measures such as improved sanitation and the provision of safe water supplies, public enlightenment is necessary to ensure early presentation and improved survival.