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Complications of typhoid fever requiring laparotomy during childhood
F Kizilcan1, F C Tanyel, N Büyükpamukçu
1Department of Pediatric Surgery, Hacettepe University, Faculty of Medicine, Ankara, Turkey.
Insights
Typhoid fever complications like intestinal perforation and splenic abscess are rare in children but significantly increase mortality. Early detection and prediction of these surgical emergencies remain challenging for pediatric surgeons.
Area of Science:
- Pediatric Surgery
- Infectious Diseases
- Gastroenterology
Background:
- Typhoid fever is a significant cause of morbidity and mortality in children, particularly in endemic regions.
- Complications requiring surgical intervention, such as intestinal perforation, gastrointestinal bleeding, and splenic abscess, pose a substantial challenge.
Purpose of the Study:
- To retrospectively analyze the frequency and outcomes of typhoid fever complications requiring laparotomy in children.
- To identify risk factors and predictive criteria for these surgical complications.
Main Methods:
- Retrospective analysis of 680 children diagnosed with typhoid fever between 1981 and 1990.
- Data collection on complications requiring laparotomy, including intestinal perforation, gastrointestinal bleeding, and splenic abscess.
- Statistical analysis to determine frequencies, risk factors (age, sex), and outcomes.
Main Results:
- Overall complication rate requiring laparotomy was 1.17%, with intestinal perforation (0.58%), gastrointestinal bleeding (0.29%), and splenic abscess (0.29%) being the most common.
- Complication risk was higher in males (1.58%) and children over 6 years of age.
- No clinical or laboratory findings predicted the occurrence of complications; perforation and bleeding occurred within 10 days, splenic abscess within 10-30 days.
- Mortality increased from 1.78% to 25% in patients with surgical complications.
Conclusions:
- Typhoid fever complications requiring laparotomy are infrequent but associated with high mortality, posing a challenge in pediatric surgery.
- The absence of predictive criteria for these complications highlights the need for vigilant monitoring and prompt surgical management.
- Further research is needed to develop predictive tools and improve outcomes for children with severe typhoid fever.
Abstract:
All the complications requiring laparotomy among 680 children who were diagnosed as having typhoid fever between 1981 and 1990, at Hacettepe University Children's Hospital, were retrospectively analyzed. Four patients developed intestinal perforation, two gastrointestinal bleeding, and two splenic abscess, with frequencies of 0.58%, 0.29%, and 0.29%, respectively. The overall frequency was 1.17%. While the risk was 1.58% among males, it was 0.42% among females with no statistically significant difference (P > .05). The risk was higher among patients above 6 years of age (P < .05). While perforation and hemorrhagic complications developed within 10 days of initial symptoms and splenic abscess required 10 and 30 days for development, there were no clinical signs and laboratory findings predicting the occurrence of complications in the course of typhoid fever. Two patients, one with intestinal perforation and the other with gastrointestinal hemorrhage, died within 2 days following the septic postoperative courses. On the other hand, 12 patients, among those without complications requiring laparotomy, died of unremitting septic course of the disease. The mortality rate rose from 1.78% to 25% when complications occurred. The findings in this series demonstrate that typhoid fever presents a challenge to the pediatric surgeons not only because of the complications requiring laparotomy with high mortality rates, but also the absence of criteria predicting the occurrence of complications in the course of typhoid fever.