Typhoid perforation in children: an unrelenting plague in developing countries

Abstract

Introduction: Despite global scientific development, typhoid fever and subsequent typhoid perforation have continued to be common in developing countries. The aim of this study was to re-evaluate the pattern of presentation and management outcomes as well as morbidity and mortality of typhoid perforation among children.

Methodology: Children aged 15 years and under with clinical diagnosis of typhoid perforation were retrospectively studied by reviewing their hospital records between January 2006 and December 2015. Demographic and clinical data were analyzed with SPSS using descriptive statistics and the chi-squared test or Cramer’s V for continuous and categorical variables respectively.

Results: 105 children had typhoid fever, 56 (53.3%) of them were diagnosed with typhoid perforation and 49 were confirmed intra-operatively. Of the children, 55.1% (n = 27) were school-aged while the remaining were adolescents; a majority had the classical triad of persistent fever (100%), abdominal pain (100%) and abdominal swelling (93.9%). Anaemia and hypokalaemia were common. The mean time duration for resuscitation was 16 hours (range 6-36 hours). Most perforations were single (n=36, 73.5%). There were more perforations in the school-aged than adolescent children (p = 0.845; V = 0.298). Wound infection (34.7%) was the most frequent morbidity but faecal fistula (10.2%) was most troublesome to manage. Death followed severe sepsis and chest infections in four children (8.2%).

Conclusion: Typhoid perforation continues to cause morbidity and mortality in children in developing countries. To stem this endemic disease, community health education and improved living conditions are required.