Peritonitis in children: our experience in Benin City, Nigeria.

BACKGROUND: Peritonitis is a surgical emergency of variable etiology with a high mortality rate, particularly in children. This paper reports our experience with the epidemiology and outcome of management of childhood peritonitis in an African setting. PATIENTS AND METHODS: Consecutive children with peritonitis managed over six years (2004-2009) at the University of Benin Teaching Hospital, Nigeria, were included in this prospective experience after approval by the local Ethics Committee. RESULTS: Of the 721 children aged between one day and 18 years (mean 5 ± 4.2 years), comprising 415 males and 306 females (male/female ratio 1.4:1) who were managed for gastrointestinal disease, 182 (25.2%) developed peritonitis, 179 (98.4%) preoperatively and three (1.6%) postoperatively. Secondary bacterial peritonitis most often followed complicated appendicitis (120; 65.9%), intussusception (13; 7.1%), volvulus (5; 2.7%), and intestinal atresia (4; 2.2%). Peritonitis was generalized in all children younger than 11 years but less so after that age, and the outcome was poorest in neonatal infants, who accounted for 14 (63.6%) of the 18 peritonitis-related deaths (p < 0.0001). All the children had thorough peritoneal irrigation and lavage that included the insertion of drains in cases of localized peritonitis. The choice of antibiotics and additional surgical options that included bowel resection and anastomosis, stoma creation, and closure of perforation depended on the primary pathology and bacteriology findings. The duration of hospitalization was increased to between seven days in older children with localized peritonitis and 25 days in neonatal infants with generalized peritonitis compared with 3-5 days in children with similar pathology who did not have peritonitis (p < 0.0001). CONCLUSION: Peritonitis was severe and generalized in younger children, especially neonatal infants, who accounted for the majority of the deaths recorded. Early referral of children, particularly neonatal infants, having gastrointestinal complaints for surgical consultation and prompt surgical management is recommended to prevent peritonitis and to improve the outcome of children with the disease.

Typhoid ileal perforation in children in Benin city.

BACKGROUND: Typhoid ileal perforation is a common complication of typhoid fever, a multi-systemic infection, which is endemic in many developing countries. OBJECTIVE: This study reviews and compares the incidence, morbidity and mortality at the University of Benin Teaching Hospital with other referral centres located in areas with similar socioeconomic and population status. MATERIALS AND METHODS: The incidence, morbidity and mortality of typhoid ileal perforation in children treated among Edo People at the University of Benin Teaching Hospital, Nigeria, in the period from 1993 to 2007 were retrospectively studied and compared with centres in localities of similar socioeconomic and population status. RESULTS: Twelve children, all of middle class parents who resided in suburban community with poor water supply and substandard sewage disposal, accounted for 70.6% patients with typhoid ileal perforation managed over 15 years while 29.4% occurred in adults. The children comprised seven males and five females (M/F ratio 1.4:1), aged between five and 13 (average 9) years. This number seen over 15 years in this centre was extremely low when compared with other referral centres; as many as 191 patients were seen over 10 months in one of the centres. The few patients seen were traced to cultural beliefs in Benin City, which influenced proper sewage disposal by the about four million Edo people, especially those living in rural areas. Consequently, no child from the rural area with clean natural water supply or urban areas with pipe born water supply where sewages are disposed of properly had typhoid perforation. Unacceptably high morbidity (100%) and mortality (75%) due to late referrals were recorded in comparison with other centres. CONCLUSION: Proper sewage disposal may have influenced the low incidence in this centre but early referral is advocated so as to reduce the high associated morbidity and mortality.

Typhoid ileal perforation in children in Benin city

Background: Typhoid ileal perforation is a common complication of typhoid fever; a multi-systemic infection; which is endemic in many developing countries. Objective: This study reviews and compares the incidence; morbidity and mortality at the University of Benin Teaching Hospital with other referral centres located in areas with similar socioeconomic and population status. Materials and Methods: The incidence; morbidity and mortality of typhoid ileal perforation in children treated among Edo People at the University of Benin Teaching Hospital; Nigeria; in the period from 1993 to 2007 were retrospectively studied and compared with centres in localities of similar socioeconomic and population status. Results: Twelve children; all of middle class parents who resided in suburban community with poor water supply and substandard sewage disposal; accounted for 70.6patients with typhoid ileal perforation managed over 15 years while 29.4occurred in adults. The children comprised seven males and five females (M/F ratio 1.4:1); aged between five and 13 (average 9) years. This number seen over 15 years in this centre was extremely low when compared with other referral centres; as many as 191 patients were seen over 10 months in one of the centres. The few patients seen were traced to cultural beliefs in Benin City; which influenced proper sewage disposal by the about four million Edo people; especially those living in rural areas. Consequently; no child from the rural area with clean natural water supply or urban areas with pipe born water supply where sewages are disposed of properly had typhoid perforation. Unacceptably high morbidity (100) and mortality (75) due to late referrals were recorded in comparison with other centres. Conclusion: Proper sewage disposal may have influenced the low incidence in this centre but early referral is advocated so as to reduce the high associated morbidity and mortality