Operative management of typhoid ileal perforation in children

Intestinal perforation resulting from complicated typhoid fever still causes high morbidity and mortality. The purpose of the present study is to evaluate the outcome of its surgical management in Nigerian children.

Emergency laparotomy and repair of the ileum was performed on 46 children with typhoid ileal perforation at the Federal Medical Centre (FMC), Azare, Nigeria, between January 2004-December 2008. This was followed by copious peritoneal lavage with warm normal saline and mass closure of the abdomen.

There were 28 (60.86%) boys and 18 (39.13%) girls, with a mean age of 9.5 +/- 3.22 (range, 15 months-15 years). Abdominal pain (45), fever (44), and abdominal distention (36) were the most common presenting symptoms and majority of the patients (36) perforated within 14 days of illness. Solitary ileal perforations were the most common pathology, found in 31 (67.4%) cases. Simple closure of the perforations after debridement of the edges was the most frequent operative procedure performed. A total of 21 patients had one or more complications which included wound infection (21), postoperative fever (16), and wound dehiscence (6). Postoperative anaemia was a problem in 23 (50%) patients. The mortality rate was (13) 28.3%. The mean duration of hospital stay for survivors was 22.9 +/- 12.3 (range, 6-46 days). This was not significantly affected by the location or number of perforations on the ileum.

The clinical course of typhoid ileal perforation may be different for the very young. The typically high rate of complications can be reduced if operation is undertaken earlier. Solitary ileal perforations can be managed safely with simple closure.