SURGICAL LESSONS LEARNED FROM THE SHIGELLA-DYSENTERIAE TYPE-I EPIDEMIC

An epidemic of Shigella dysenteriae type I is spreading through Africa . It is a particularly infectious and virulent form of dysentery which can cause clinical confusion with other endemic diseases and may pres ent to the surgeon as a result of its complications. A total of 140 ch ildren with Shigella dysenteriae type I presented to the paediatrician s at Ring Edward VIII Hospital in 1995; 35 were referred to the surgeo ns because of abdominal tenderness, distension, peritonitis or perfora tion. Ten children underwent laparotomy-four for peritonitis and six f or perforation. Of the four children with peritonitis, three had trans mural colitis. Therefore laparotomy was only performed for objective e vidence of perforation. Of the subsequent non-operated group with the clinical features of peritonitis, none developed further surgical prob lems in the acute phase and none died. It is suggested that surgery in the acute phase should be avoided unless there is evidence of perfora tion.