Résultats de la prise en charge des perforations iléales typhiques : à propos de 29 cas à Ouahigouya (Burkina Faso)

Abstract

The aim of this study was to determine the results of management of typhoid perforations. This was a descriptive cross-sectional study carried out from January 1, 2016 to December 31, 2016 in the General Surgery Department of the Regional Teaching Hospital Center of Ouahigouya (Burkina Faso). It involved 29 operated patients, in whom the diagnosis of typhoid perforation was confirmed at laparotomy: age, sex, admission time, clinical, therapeutic and prognostic aspects were analyzed. Typhoid perforations accounted for 20% of acute generalized peritonitis and 38.1% of digestive perforations. Twenty-three patients were males and six were females (sex-ratio: 3.8). The average age of patients was 19 years. The mean diagnostic time was 9.8 days. The excision-suture of the perforation was the most used technique with 62% of the cases. The treatment lead to complications in 10 cases with a morbidity of 34.5%. Four deaths were recorded, representing an overall mortality of 13.8%. Prognostic factors were diagnostic delay, age, number of perforations and resection-anastomosis.

Clinical Epidemiology and Surgical Treatment of Spontaneous Perforations of the Terminal Ileum: A Multicentre Study in Cameroon

“…Perforations of the terminal ileum are associated with very high post-operative morbidity and mortality [4] [5]. The complication rate recorded in this series is close to that reported by other authors [14] [16] [17]. Higher rates have also been reported [9] [15] [20].…”

“…Perforations of the terminal ileum may mimic appendicular perforation or other pathologies such as duodenal ulcers or ileitis, which result in the delay of surgical treatment, which is often the only way to make the diagnosis. The average age in our study was the same as in another African study [14] and higher than the average of 13.8 years reported in a series from Burkina Faso [15]. Some Asian series have found higher mean ages [2] [16] [17].…”

“…Perforations of the terminal ileum frequently lead to severe stercoral peritonitis. Added to this is the delay in diagnosis already mentioned above, which is constant in most authors on the continent [14] [15] [18] [20]. This significant morbidity is responsible for an often lengthy hospital stay, as observed in this series and in many others [5] [15] [16] [17] [20], with significant financial consequences for patients and their families.…”

“…We conducted a multicentre retrospective review of the surgical management of non-traumatic perforations of the terminal ileum. These remain a major complication and a diagnostic, therapeutic and surgical challenge, especially in underdeveloped and developing countries [1] [2] [3] [14]. Perforations of the terminal ileum may mimic appendicular perforation or other pathologies such as duodenal ulcers or ileitis, which result in the delay of surgical treatment, which is often the only way to make the diagnosis.…”

“…Typhoid fever is the main cause of spontaneous perforation of the terminal ileum in endemic areas [1] [2] [21] [22]. However, this diagnosis remains presumptive and is most often made intraoperatively [14]. The clinical presentation is that of any other acute abdomen.…”