[Typhoid perforations: experiences in a surgical setting in Cameroon. Apropos of 49 cases]

Over a period of 3 years, 49 typhoid perforations of the small intestine were treated at Yaoundé Central Hospital. These 34 men and 15 women with a mean age of 29.6 years presented sthenic peritonitis in 20 cases and more difficult to diagnose asthenic peritonitis in 29 cases. The perforation was always located at the end of the ileum and was single in 40 cases, double in 6 cases and triple in 3 cases. Surgical management in association with intensive care and multiple agent antimicrobial therapy consisted in sleeve resection in 29 cases, resections with an exteriorized anastomosis in 15 cases, and ileocolonic intubation in 5 cases. The postoperative complications were suppuration of the wall (n = 4), intestinal fistula (n = 3), evisceration, and residual abscess. There were 9 deaths (18.4%) including 4 after sleeve resection and 5 after resection with an exteriorized anastomosis. On the basis of this experience, the authors describe the diagnostic difficulties posed by typhoid perforations, discuss surgical techniques proposed in the literature, and emphasize the value of sleeve resection.