Typhoid intestinal perforations at a University teaching hospital in Northwestern Tanzania: A surgical experience of 104 cases in a resource-limited setting

World Journal of Emergency Surgery

Japhet M Gilyoma³  Geofrey Giiti³  Mabula D Mchembe⁴  Mariam Mirambo¹  Stephen E Mshana¹  Hyasinta Jaka²  Johannes B Kataraihya²  Mheta Koy²  Joseph B Mabula³  Phillipo L Chalya³ 

[1] Department of Microbiology and Immunology, Catholic University of Health and Allied Sciences-Bugando, Mwanza, Tanzania;Department of Internal Medicine, Catholic University of Health and Allied Sciences-Bugando, Mwanza, Tanzania;Department of Surgery, Catholic University of Health and Allied Sciences-Bugando, Mwanza, Tanzania;Department of Surgery, Muhimbili University of Health and Allied Sciences, Dar Es Salaam, Tanzania

关键词: Tanzania;    Prognostic factors;    Surgical management;    Intestinal perforation;    Typhoid fever;   

Others  :  792501
DOI  :  10.1186/1749-7922-7-4

 received in 2012-01-22, accepted in 2012-03-08,  发布年份 2012

【 摘 要 】

Background

Typhoid intestinal perforation is still prevalent in many developing countries. Despite the advances in the management, the outcome in these patients in resource limited countries is still very poor. This study was to review our experiences on the surgical management of typhoid intestinal perforation and to determine the prognostic factors for mortality in our local setting.

Methods

This was a combined retrospective and prospective study of patients who were operated for typhoid intestinal perforation at Bugando Medical Centre between August 2006 and September 2011. Data collected were analyzed using SPSS computer software version 15.

Results

A total of 104 patients were studied representing 8.7% of typhoid fever cases. Males were affected twice more than the females (2.6:1). Their ages ranged from 8 to 76 years with a median age of 18.5 years. The peak age incidence was in the 11-20 years age group. Fever and abdominal pain were the most common presenting symptoms and majority of the patients (80.8%) perforated between within 14 days of illness. Chest and abdominal radiographs revealed pneumoperitonium in 74.7% of cases. Ultrasound showed free peritoneal collection in 85.7% of cases. Nine (10.2%) patients were HIV positive with a median CD4+ count of 261 cells/μl. The perforation-surgery interval was more than 72 hours in 90(86.5%) patients. The majority of patients (84.6%) had single perforations and ileum was the most common part of the bowel affected occurring in 86.2% of cases. Simple closure of the perforations was the most commonly performed procedure accounting for 78.8% of cases. Postoperative complication rate was 39.4% and surgical site infection was the most frequent complication in 55.5% of cases. Mortality rate was 23.1% and it was statistically significantly associated with delayed presentation, inadequate antibiotic treatment prior to admission, shock on admission, HIV positivity, low CD4 count (< 200 cells/μl), high ASA classes (III-V), delayed operation, multiple perforations, severe peritoneal contamination and presence of postoperative complications (P < 0.001). The median overall length of hospital stay was 28 days.

Conclusion

Typhoid intestinal perforation is still endemic in our setting and carries high morbidity and mortality. This study has attempted to determine the factors that statistically influence mortality in typhoid perforation in our environment. Appropriate measures focusing at these factors are vital in order to deliver optimal care for these patients in this region.

【 授权许可】

   
2012 Chalya et al; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

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