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Enteric Fever Complicated by Intestinal Perforation in Children: A Persistent Health Problem Requiring Surgical
Muhammad Azhar1, Naima Zamir2, Mishraz Shaikh3
1Muhammad Azhar, FCPS, Senior Registrar, Department of Paediatric Surgery, National Institute of child Health, Karachi, Pakistan.
Insights
Enteric perforation in children often presents with severe symptoms due to delayed illness, leading to high rates of complications and mortality. Early surgical intervention is crucial for improving outcomes in pediatric patients with enteric perforation.
Area of Science:
- Pediatric Surgery
- Gastrointestinal Surgery
- Clinical Research
Background:
- Enteric perforation is a critical surgical condition in children.
- Delayed presentation often leads to hemodynamic instability and sepsis.
Purpose of the Study:
- To evaluate the clinical presentation and surgical outcomes of enteric perforation in pediatric patients.
- To identify factors influencing morbidity and mortality.
Main Methods:
- A retrospective descriptive study was conducted on 97 children (≤12 years) with enteric perforation.
- Data on clinical presentation, surgical procedures, and post-operative outcomes were analyzed.
Main Results:
- High-grade fever and abdominal pain were universal; 73.19% had pneumoperitoneum.
- 52.57% were anemic, requiring transfusion. 73.19% were operated within 24 hours.
- Postoperative complications included wound infection (73.19%), intra-abdominal collections (31.95%), and burst abdomen (9.27%). Overall mortality was 12.37%.
Conclusions:
- Enteric perforation in children is associated with significant morbidity and mortality, often due to prolonged illness and resulting sepsis.
- Timely surgical management is essential, though outcomes remain challenging.
Objective:
To evaluate clinical presentation and surgical outcome in children with enteric perforation.
Methods:
A descriptive retrospective study was conducted in Department of Paediatric Surgery at National Institute of Child Health, Karachi from August 2016 and September 2019, in children 12 years of age and under with diagnosis of enteric perforation. Data about age, gender, duration of illness, hemodynamic status and baseline investigation on admission was reviewed. Details about patients operated early and those who required prolong resuscitation and were operated after 24 hours of admission, need for tube laparostomy, operative findings, type of surgical procedure performed and post-operative outcome were reviewed. Data was analyzed using SPSS version 22.
Results:
Ninety-seven patients, 60(61.85%) males and 37(38.14%) females were managed during the study period with age ranged from 3-12 years (mean 7.82, ± 2.94 years).and duration of symptoms ranged from 7-30 days (mean 15.56, ± 9.39days). High grade fever and abdominal pain were seen in all patients (100%). Pneumoperitoneum was noted in 71(73.19%) cases on X-ray abdomen. Fifty-one (52.57%) children were anemic and required blood transfusion before surgery. Seventy-one (73.19) patients were optimized and operated within 24 hours while 28(28.86%) cases required more resuscitation so tube laparostomy was done initially and operated after 24 hours. Seventy nine (81.44%) cases had single perforation, 14(14.43%) cases had multiple and four had sealed perforation. Primary repair of perforation was done in 37(38.14%) cases, while ileostomy in 65(76.01%) cases. Postoperatively wound infection was seen in 71(73.19%) cases, intra-abdominal collections in 31(31.95%) and burst abdomen in nine (9.27%) cases. Overall mortality was 12.37%. Till date in 47 patients (72.30%) reversal of stoma has been done.
Conclusions:
Enteric perforation in children presents usually with hemodynamic instability and sepsis due to prolong period of illness. Therefore, regardless of surgical procedure performed it is associated with high morbidity and mortality.
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