One of the most severe complications of typhoid fever is perforation of the ileum (TPI); it is also a cause of high morbidity and mortality in endemic areas. After surgery for TPI, other complications may set in postoperatively, compounding the problem. A prospective study of 121 children who were operated upon for TPI to identify the postoperative complications showed that the most common was wound infection. The most serious were: mechanical intestinal obstruction, abdominal dehiscence, and enterocutaneous fistulae. Physicians caring for such children should be aware of these complications and their mode of presentation so as to quickly and decisively manage them to prevent more deaths.

Background: Acute abdominal conditions are a common reason for emergency admission of children. Little is available in the literature about such conditions in our subregion, especially Ghana. Objective: The aim of this study was to investigate the range of emergency abdominal surgical conditions amongst children in the subregion, with particular reference to Komfo Anokye Teaching Hospital, Kumasi, Ghana. A prospective survey of all children older than 1 year undergoing an emergency abdominal surgery was carried out. Methods: Details of all children (except infants) operated for an acute surgical abdominal condition over a 5-year period were entered into a specially designed form, capturing patient characteristics, surgical causes of the emergency, operative procedure, complications, morbidity and mortality rates. Results: Nine hundred fi fty-fi ve children aged Ͼ1 year but Ͻ15 years were enrolled in the study. The mean age was 8.8 Ϯ 3.2 years. The leading causes of surgical abdominal emergencies were typhoid perforation (TP) of the gastrointestinal tract (GIT), 68%; acute appendicitis, 16%; abdominal trauma and intestinal obstruction (including intussusception), 4.7% each; irreducible external hernias, 2.5%; primary peritonitis, 1.0%; gallbladder disease and gastric perforation, 0.8% each. Many children died from the TP group; case fatality for TP alone was 12.6%. The overall mortality was 9.7%. Morbidity was infl uenced by the presence of major peritoneal contamination, continuing peritonitis and surgical site infections (SSIs), which led to long hospital stay. Conclusions: In our hospital, TP of the GIT, acute appendicitis, intestinal obstruction, irreducible external hernias and primary peritonitis were the most common abdominal emergencies encountered in children after infancy. The high morbidity and mortality in TP is attributable to ignorance, poor sanitation and delay in reporting to hospital for treatment.

No abstract

Intussusception is very common in children all over the world, especially those under 2 years. This can be ileoileal, ileocolic, or colocolic, i.e. the immediate proximal part of the intestine telescoping into the distal portion of the intestine. Ileosigmoid intussusception involves the invagination of a loop of the ileum into the sigmoid colon, producing two obstructions: that involving the invaginated loop of terminal ileum and that of the sigmoidorectal intussusception. This can lead to ischaemia and necrosis of either the ileum or sigmoid colon. The case presented here is suspected to be the first one reported in the world scientific literature.