Typhoid ileal perforation in children: does clinical diagnosis alone justify laparotomy?

Introduction: Typhoid ileal perforation is one of the most common surgical complications of typhoid fever, with high morbidity and mortality in resource poor tropical areas in Africa and other developing countries. Objective: The aim of this study was to evaluate clinical diagnosis of typhoid ileal perforation as justification for laparotomy. Method: A retrospective study from January 2008 to December 2011 in the Paediatric Surgery Division of the University of Abuja Teaching Hospital. Results: The age group most commonly affected was aged 6-9 years (43.5%); there were 20 (43.5%) males and 26 (56.5%) females. The commonest clinical features were fever, vomiting, abdominal pain, tenderness and distension (52.3%). Thirty one (67.4%) of the patients did not have any diagnostic radiological investigations. Fifteen (32.6%) patients had superficial wound infection, ten (21.7%) died, eleven (23.9%) had no complications. Conclusion: We advocate that under circumstances where urgent diagnostic radiological and laboratory investigations are not available promptly, clinical diagnosis of typhoid ileal perforation, especially signs of peritonitis should justify an emergency laparotomy

Les perforations intestinales d'origine typhique à Brazzaville

Les perforations intestinales d'origine typhique sont encore frequentes et graves au Congo. En 2 ans; de mars 1988 a fevrier 1990; 26 perforations ont ete traitees. Parmi les patients 16/26 soit 61 pour cent ont moins de 20 ans. La perforation siegeait sur la derniere anse ileale entre 5 et 50 cm de la volvule de bauhin. les delais entre l'installation du premier signe et le moment de l'operation varient de 24 heures a 21 jours. Il a ete realise une suture simple; 5 ileostomies laterales; 8 resection-anastomoses; et 12 ilestomies terminales