Typhoid Perforation: Determinants of Outcome in Children in Ile-Ife; Nigeria

Background: Ileal perforation can be a fatal complication of typhoid fever in children as its clinical presentation is often atypical. The risk of death from intestinal perforation in typhoid fever is more than four times when compared with patients without perforation. A high index of suspicion therefore; and early intervention are mandatory to reduce morbidities and deaths due to this disease in children. Aim: To highlight the factors that adversely influence treatment outcome following typhoid ileal perforation in a paediatric population and how they could be modified to reduce morbidity and mortality. Methods: This was a retrospective study whereby medical records of children aged 1 to 15 years with typhoid fever admitted to OAUTHC; Ile-Ife; over a 10-year period; 1994-2004. Results: A total of 38 patients; 20 males and 18 females in the ratio 1.1:1; were managed for typhoid perforation during the 10-year study period. Twenty-nine patients (76.3) survived while 9 (23.7) died. Of the many factors evaluated; only the duration of time before operation was found to significantly influence treatment outcome adversely (P=0.009); while large single or large multiple perforations (P=0.256); severe peritoneal contamination (P=0.291) and extensive surgery (P=0.089) did not. Conclusion: Typhoid ileal perforation has a poor treatment outcome in children in Ile-Ife; Nigeria. The duration of time before operation was the single most important factor that adversely affected treatment outcome. Therefore; swift preoperative resuscitation and early surgical intervention will enhance overall outcome irrespective of the number of perforations; severity of faecal contamination and extent of surgery

The role of preoperative antibiotics in the prevention of wound infection after day case surgery for inguinal hernia in children in Ile Ife, Nigeria.

PURPOSE: Day case surgery for inguinal hernia had been an established practice of the Paediatric Surgery Unit, OAUTHC, Ile Ife for about two decades. In a retrospective review of the practice from the same center, a high incidence of postoperative wound infection was noted, which was attributed to the poor personal hygiene of the patients. This prospective study, therefore, was performed to evaluate the role of a single dose of preoperative antibiotic (using gentamicin) in the prevention of these wound infections after day case surgery for inguinal hernia in children. METHODS: This was a prospective study carried out over a period of 8 months from 11 April 2004 to 20 December 2004. During this period, 88 children aged from birth to 15 years were randomized into two groups of equal numbers to undergo elective inguinal herniotomy. The children in the test group received prophylactic intravenous gentamicin, 30 min before a groin crease incision was made, while those in the control group did not. All patients were subsequently followed up for 32 days for any evidence of a wound infection. RESULTS: There were 104 wounds in the ratio of 50:54 in the control and test groups, respectively. All 54 wounds of the children who received prophylactic gentamicin healed primarily and without complication. Five cases of wound infections occurred in the control group, giving an infection rate of 4.8% (P < 0.041). Staphylococcus aureus was the single pathogen isolated from the infected postherniotomy wounds and this organism was wholly sensitive to gentamicin. CONCLUSION: From the findings in this study, administration of preoperative gentamicin has a role in the prevention of wound infection after day case surgery for inguinal hernias in susceptible children. Preoperative intravenous gentamicin is therefore recommended as a prophylactic measure against wound infection after day case surgery for inguinal hernias in those children at risk of wound infection.

Day case inguinal hernia surgery in Nigerian children: prospective study.

BACKGROUND: There has been an increase in day case surgery for children worldwide, but there have been few reports of the practice (most of them being retrospective) by many of the surgical sub-specialties in the sub-region. The aim of this study was to document our experience with day case inguinal hernia surgery in a developing economy. MATERIALS AND METHODS: This was a prospective study of uncomplicated inguinal hernias treated as day case at OAUTHC between April 2004 and December 2004. Data were collected and analysed. RESULTS: Eighty-eight patients were recruited into the study and none defaulted. There were 88 patients, (M:F = 16.6:1). A majority (n = 54) of the hernias occurred on the right side, while just a few (n = 18) occurred on the left. There were 5 cases of wound infections giving an infection rate of 4.8%. In all, the morbidity following day case inguinal hernia surgery was slight and no patient required readmission into the hospital. CONCLUSION: Day case inguinal hernia surgery in children is safe and well accepted by patients and parents alike. Health institutions in which children with inguinal hernias still queue for long periods for space on the operation list need to adopt day case surgery for inguinal hernia in order to forestall the risk of their obstruction.

Day case inguinal hernia surgery in Nigerian children: prospective study

Background: There has been an increase in day case surgery for children worldwide; but there have been few reports of the practice (most of them being retrospec-tive) by many of the surgical sub-specialties in the sub-region. The aim of this study was to document our experience with day case inguinal hernia surgery in a developing economy. Materials and Methods: This was a prospective study of uncomplicated inguinal hernias treated as day case at OAUTHC between April 2004 and December 2004. Data were collected and analysed. Results: Eighty-eight patients were recruited into the study and none defaulted. There were 88 patients; (M:F = 16.6:1). A majority (n = 54) of the hernias occurred on the right side; while just a few (n = 18) occurred on the left. There were 5 cases of wound infections giving an infection rate of 4.8. In all; the morbidity following day case inguinal hernia surgery was slight and no patient required readmission into the hospital. Conclusion: Day case inguinal hernia surgery in children is safe and well accepted by patients and parents alike. Health institutions in which children with inguinal hernias still queue for long periods for space on the operation list need to adopt day case surgery for inguinal hernia in order to forestall the risk of their obstruction