Profile of Abdominal Surgical Complications of Enteric Fever in Children in a Developing Country

Abstract

Background: Surgical complications of enteric fever has been associated with significant morbidity and mortality. The aim of this study was to determine the pattern and outcome of the treatment of abdominal surgical complications of enteric fever in children in a teaching hospital in Enugu, Nigeria.
 Methods: This retrospective study included children who had undergone a surgery for abdominal complications of enteric fever at the pediatric surgery unit of Enugu State University Teaching Hospital (ESUTH), Enugu, Nigeria. The medical records of the pediatric patients over a five-year period were evaluated for the patients’ demographics, presenting symptoms, investigations, intraoperative findings, procedures performed, and postoperative complications and outcome.
 Results: During the study period, there were 44 cases of abdominal surgical complications of enteric fever with an age range of 6–14 years (mean 9.5 years) and the male to female ratio of 2.7:1. The mean duration of symptoms prior to presentation was five days. All the patients had fever and abdominal pain. While 95% of the patient had typhoid intestinal perforation, 5% had typhoid hemorrhage. Primary closure of intestinal perforation and right hemicolectomy with ileotransverse anastomosis were performed for typhoid intestinal perforation and typhoid intestinal hemorrhage, respectively. Surgical site infection was the most common postoperative complication. The mortality rate was 6.8%.
 Conclusion: Abdominal surgical complications of enteric fever are still obtainable in developing countries. Typhoid intestinal perforation was the most common complication recorded in the present study.
 Keywords: abdominal, children, enteric fever, surgical complications

Frequency of Anastomosis Leak in Primary Repair in Ileal Perforation

“…However, we did not observe high mortality for male patients, although this is reported by others and attributed perhaps to the fact that males spend more time than females in outdoor activities 22 . Factors that correlate with greater mortality are neutropenia and severe peritoneal contamination, as confirmed by the literature's data 23 . However, a large number of patients ultimately found to have an anastomotic leak develop a more insidious presentation, often with low-grade fever, prolonged ileus, or failure to thrive.…”

Rare Case of Gallbladder Perforation in Pediatric Patient: A Pitfall in Generalized Peritonitis in Late Presented Typhoid Fever

“…Generalized peritonitis in patients with enteric fever may be differentially diagnosed with perforated intestine, intestinal hemorrhage, and rarer cases of perforated gallbladder and appendicitis. We report a case of pediatric gallbladder perforation found during surgical exploration which was presented as generalized peritonitis and at first diagnosed with perforated appendicitis or perforated small intestine [1][2][3].…”

“…Abdominal surgical complications are one of most common complications (10-15% of typhoid fever patients) in pediatric typhoid fever, but gallbladder perforation is an uncommon one. Emergency surgical exploration with cholecystectomy was initiated and showed satisfying outcome [1].…”