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Perforated typhoid enteritis in children
V Gupta1, S K Gupta, V K Shukla
1Department of Pediatrics, Banaras Hindu University, Varanasi, India.
Insights
Surgical management of perforated typhoid enteritis in children is critical. Early intervention and resuscitation significantly improve survival rates, but prevention through improved sanitation and safe water is key to reducing mortality.
Area of Science:
- Pediatric Surgery
- Infectious Diseases
- Gastroenterology
Background:
- Typhoid enteritis, a severe complication of Salmonella Typhi infection, frequently presents with intestinal perforation in children.
- Operative management is often required for perforated typhoid enteritis, carrying significant risks of morbidity and mortality.
Purpose of the Study:
- To evaluate the outcomes of surgical management for perforated typhoid enteritis in pediatric patients.
- To identify factors influencing mortality in this patient cohort.
Main Methods:
- A prospective study was conducted on 65 pediatric patients (ages 5-15) with perforated typhoid enteritis.
- All patients underwent surgical intervention, with 86% receiving two-layer bowel closure after ulcer margin freshening.
Main Results:
- The overall mortality rate was 20%.
- Factors associated with increased mortality included prolonged perforation duration, shock, and fecal peritonitis.
- Early surgical intervention and resuscitation were associated with improved outcomes.
Conclusions:
- Prompt surgical treatment and resuscitation are vital for improving survival in perforated typhoid enteritis.
- Preventive measures, including safe drinking water and improved sanitation, are essential to reduce the incidence and mortality of typhoid fever.
Abstract:
A prospective study of 65 patients with perforated typhoid enteritis managed operatively over a 3 year period at a university hospital is presented. There were 45 males and 20 females with ages ranging from 5 to 15 years. Presenting symptoms were fever, abdominal pain, vomiting and either diarrhoea or constipation. All the patients were subjected to surgery and 56 (86%) underwent two-layer bowel closure after freshening of ulcer margins. The overall mortality rate in this study was 20% and was adversely influenced by the increasing duration of perforation, presence of shock and faecal peritonitis. Early surgery after prompt and adequate resuscitation is life saving. However, prevention of typhoid fever by providing safe drinking water and better sanitary conditions appears to offer the best chance of decreasing the high rates of mortality and morbidity of this deadly disease.