Typhoid perforation in children: an unrelenting plague in developing countries.

INTRODUCTION: Despite global scientific development, typhoid fever and subsequent typhoid perforation have continued to be common in developing countries. The aim of this study was to re-evaluate the pattern of presentation and management outcomes as well as morbidity and mortality of typhoid perforation among children. METHODOLOGY: Children aged 15 years and under with clinical diagnosis of typhoid perforation were retrospectively studied by reviewing their hospital records between January 2006 and December 2015. Demographic and clinical data were analyzed with SPSS using descriptive statistics and the chi-squared test or Cramer's V for continuous and categorical variables respectively. RESULTS: 105 children had typhoid fever, 56 (53.3%) of them were diagnosed with typhoid perforation and 49 were confirmed intra-operatively. Of the children, 55.1% (n = 27) were school-aged while the remaining were adolescents; a majority had the classical triad of persistent fever (100%), abdominal pain (100%) and abdominal swelling (93.9%). Anaemia and hypokalaemia were common. The mean time duration for resuscitation was 16 hours (range 6-36 hours). Most perforations were single (n=36, 73.5%). There were more perforations in the school-aged than adolescent children (p = 0.845; V = 0.298). Wound infection (34.7%) was the most frequent morbidity but faecal fistula (10.2%) was most troublesome to manage. Death followed severe sepsis and chest infections in four children (8.2%). CONCLUSION: Typhoid perforation continues to cause morbidity and mortality in children in developing countries. To stem this endemic disease, community health education and improved living conditions are required.

Klippel Trenaunay Syndrome: A Case Report in an Adolescent Nigerian Boy.

AIM: This is to report a case of Klippel Trenauay Weber syndrome in a fifteen year old Nigerian boy. This is a rare syndrome and it is the first case to be reported in UCTH Calabar. CASE PRESENTATION: Product of a full term uneventful pregnancy, delivered to non-consanguineous apparently healthy parents. At birth was noted to gradually develop swelling on the right leg, worse at the right foot. There was crossed hemi-hypertrophy with right leg bigger than the left. As child grew symptoms worsened, parents separated and eventually he was abandoned to the streets. He presented at University of Calabar Teaching Hospital for medical care at the age of fifteen years with lymphatic obstruction, persistent foul smelling drainage, lipodermatosclerosis of right foot as well psycho-social and financial constraints. The diagnosis was made with x-rays and Doppler studies of the lower limb vessels. He is currently being managed conservatively with compression dressings on the affected limbs, Antibiotics for the infection and analgesics. De-bulking surgery is being anticipated at this time. CONCLUSION: This is a case of KTWS presenting in adolescence and due to its rarity in Nigeria, this report is to increase awareness.