Intestinal perforation due to typhoid fever in Karamoja (Uganda)

This is a retrospective analysis of patients operated for typhoid perforation, aiming to analyze epidemiology, clinical-diagnostic and therapeutic aspects, mortality and prognosis.

47 patients were operated at Matany Hospital from 2010 to 2016. We examined clinical files to collect data. Microbiological and isthological examinations were unavailable, so etiology was deducted operatively.

Median age: 17.85 years, 61.7% of patients were male, 74.47% perforated within two weeks from the onset of symptoms. Every radiological investigation (X-Rays and Ultrasound Scans) resulted positive. 40 patients underwent primary repair, 4 underwent resection. 72.34% experienced postoperative complications, SSI (Surgical Site Infection) occurred in 40.42%. Mortality rate reached 5.56% in patients without organ failure (vs 31.03%) and 11.76% (vs 20.51%) in patients operated within 24 hours from perforation. An MPI (Mannheim Peritonitis Index) score >30 was related with a mortality rate of 36% (vs 3.45%).

Peak of incidence occurs at the end of rainy season. Majority of patients are young men. Main symptoms are fever and signs of intestinal obstruction, with a shorter period before perforation. Primary repair is the technique of choice for single perforations, resection for multiple ones, right colectomy in case of cecal involvement, ileostomy for important peritoneal contamination. SSI are the most frequent complications, enteric fistulas the most severe ones. Mortality rate is around 21.28%. Important prognostic factors are time between perforation and operation and the presence of organ failure. An MPI score >30 is related with a poorer prognosis.

Prognostic factors, Surgical treatment, Typhoid perforation, Uganda.