TYPHOID INTESTINAL PERFORATIONS IN NIGERIAN CHILDREN

This study was a retrospective analysis of 75 children with perforated typhoid enteritis treated at the Baptist Medical Centre in Ogbomoso, Nigeria over a 4-year period. The mean age was 11.4 years. The usual s ymptoms were fever and abdominal pain, with a mean duration of 10.5 da ys. The diagnosis of perforation was usually based on the history and physical examination alone. The time interval from hospital presentati on to operation was 11 hours, during which intravenous crystalloid and antibiotics were administered. Among the 75 children, 53 (71%) had a single perforation, and 22 had multiple perforations. Debridement and two-layered closure was performed in 71 (95%) and resection with anast omosis in 4 (5%). Ileus resolution was usually not complete until the eighth postoperative day, and the mean time until the surviving childr en were afebrile was 10 days. Complications other than death occurred in 7 (9%) children, and there were 15 deaths (20% mortality). All deat hs were attributed to overwhelming sepsis, and all but one of the deat hs occurred during the first 72 postoperative hours. The only factor s tatistically significant as a predictor of mortality was the duration of abdominal pain. Improvement in perioperative management including i ntensive care nursing and more effective antibiotics, although expensi ve, could result in decreased mortality. A significant decrease in mor tality can occur only when the prevention of typhoid fever becomes a h igher priority than its treatment.