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Intestinal perforation due to typhoid fever in Karamoja (Uganda)

Riccardo Conventi, Giorgio Pellis, Giandomenico Arzu

    Annali Italiani Di Chirurgia
    |June 1, 2018
    PubMed
    Abstract

    Insights

    Typhoid perforation predominantly affects young males in Uganda, with timely surgery and absence of organ failure improving survival. Primary repair is preferred for single perforations, while complications like surgical site infections are common.

    Area of Science:

    • Tropical medicine
    • Surgical gastroenterology
    • Infectious disease epidemiology

    Background:

    • Typhoid perforation is a significant surgical emergency in endemic regions.
    • Understanding its epidemiology and clinical course is crucial for improving patient outcomes.
    • This study analyzes cases from Uganda, a high-incidence area.

    Purpose of the Study:

    • To analyze the epidemiology, clinical presentation, and treatment of typhoid perforation.
    • To identify key factors influencing mortality and prognosis.
    • To evaluate surgical approaches and complication rates.

    Main Methods:

    • Retrospective analysis of 47 patients operated for typhoid perforation between 2010 and 2016.
    • Data collected from clinical files; etiology inferred operatively due to lack of microbiological/histological data.
    • Analysis of epidemiological, clinical, therapeutic, and prognostic factors.

    Main Results:

    • The majority of patients were young males (median age 17.85 years), with perforation often occurring within two weeks of symptom onset.
    • Radiological investigations were consistently positive; primary repair was performed in 40 patients, resection in 4.
    • Postoperative complications occurred in 72.34%, with Surgical Site Infection (SSI) in 40.42%. Mortality was significantly higher with organ failure and a Mannheim Peritonitis Index (MPI) score >30.

    Conclusions:

    • Typhoid perforation incidence peaks post-rainy season, primarily affecting young males with symptoms of fever and intestinal obstruction.
    • Primary repair is recommended for single perforations, with resection for multiple or cecal perforations.
    • Timeliness of surgery, absence of organ failure, and MPI score are critical prognostic indicators, with SSI being the most common complication.

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