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.