ABSTRACT
Background: Mortality from typhoid intestinal perforation remains high in the West African sub-region. The aim of this retrospective analysis was to assess the presentation pattern; mode of therapy and outcome of cases diagnosed and treated as typhoid intestina perforation at Olabisi Onabanjo University Teaching Hospital; Sagamu; between January 1990 and December 2004. Methods: Complete records of 105 adult patients were studied. Results: The male to female ratio was 2:1. The mean age was 27years. Prior to arrival in our hospital; all the patients were on various combinations of antibiotics. Twenty-seven (26) patients had been hospitalized elsewhere during the current illness Chloramphenicol was the drug of first choice in the first ten years (phase 1). It was replaced with ciprofloxacin in the subsequent five years (phase 2). Blood culture was positive for salmonella organisms in 5(4) patients. Resistance to chloramphenicol was found in three (60) out of these five positive cultures. All patients had laparotomy after resuscitation. There were 112 perforations; mostly in the ileum and jejunum. Perforations were single in one hundred and one patients and multiple in four patients. Single perforations were treated by two-layered closure; multiple perforations by primary resection and anastomosis. Fifty-five (52.4) patients developed complications. Fourteen (13.3) patients died. There was a slight drop in mortality (8.8) in phase 2. Deaths were due to septicaemia in 8(57) patients. Conclusion: The pattern of presentation and outcome of management of typhoid intestinal perforation are similar to what is observed in other centres in our local environment. However the drop in mortality rate in the last 5 years of the study and the finding of strains of salmonella typhi resistant to chloramphenicol require further evaluation
Subject(s)
Chloramphenicol , Ciprofloxacin , Disease Management , Typhoid FeverABSTRACT
Objective: The aim was to study the pattern and outcome of abdominal trauma managed by Laparotomy in Olabisi Onabanjo University teaching Hospital Sagamu (OOUTH), South Western Nigeria.Method: This is a retrospective study. The records of the patients were retrieved and relevant data extracted such as age, sex, occupation, address, cause of injury, vital signs on admission, abdominal signs, other injuries, number of units of blood transfused, investigations, indications for surgery, operative findings, procedure carried out, complications and outcome.Results: Seventy seven subjects were reviewed. There were 23 females (29.9%), and 54 males (70.1%). The age range was 3years to 68years, 32 patients (41.6%) were in 20-30 years age group. The mechanism of injury was blunt trauma in 61 (79.2%) and penetrating injury in 16 patients (20.8%). Road traffic accident was the commonest cause of injury, in 53 patients (68.8%). 42 patients (54.5%) had extra abdominal injuries. Positive paracentesis abdominis was the commonest indication for surgery, in 53 patients (68.8%). The spleen was the most commonly injured organ, in 31 patients (40.2%) while the organs were normal in 4 patients (5.2%). The complication observed includes acute renal failure, in 5 patients (6.5%), multiple organ failure in 5 patients, and wound infection in 8 patients (10.4%). Ten patients died. (13%)Conclusion: Splenic rupture is the most common abdominal injury treated by Laparotomy in OOUTH Sagamu and the commonest cause is road traffic accident. Mortality was due mainly to acute renal failure and multiple organ failure