Typhoid Fever Surgical Outcomes in West Africa Improved with Ileostomies: A Single-Hospital Study

Typhoid fever is a severe infectious disease prevalent in developing countries. This enteric fever can cause ulceration with perforation, typically in the terminal ileum. There is insufficient evidence regarding the prevalence and morbidity of perforated typhoid in endemic areas such as Togo, West Africa. Our aim was to evaluate and improve mortality rates in patients with typhoid perforation at Hospital of Hope (HOH).

A retrospective review of 180 patients with perforated typhoid at HOH in Togo, West Africa, examined surgical outcomes from January 1, 2020, to January 7, 2024. We assessed the effectiveness of a new institutional treatment protocol implemented in February 2023. The change was driven by a higher-than-expected mortality rate. Additionally, demographic, treatment, clinical, and surgical characteristics were abstracted.

From January 2020 to July 2024, the mortality rate was 20.00% (n = 36); 69.44% of patients who died suffered from septic shock (n = 25). To mitigate septic shock, HOH's protocol change lowered the threshold for damage control surgery including performing an ileostomy. This change was associated with 44% lower odds of death (15.45% vs. 25.14%, P = 0.056). The mortality rate of patients undergoing surgery with only one perforation (13.51%, n = 15/111) was lower compared to those with moderate (6.52% n = 3/46) or severe contamination (40.74%, n = 22/54) and/or multiple perforations (26.58%, n = 21/79). Of surviving patients (n = 55) with an ostomy, 85.45% (n = 47) underwent stoma reversal.

This demonstrates that ileostomies can be a safe and effective management therapy of typhoid perforations in settings of late presentation, malnutrition, and low resources.