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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
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, Volume 7, No. 1, Article 4, Year 2012
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Description
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. © 2012 Chalya et al; licensee BioMed Central Ltd.
Authors & Co-Authors
Chalya, Phillipo L.
Tanzania, Mwanza
Catholic University of Health and Allied Sciences
Mabula, Joseph B.
Tanzania, Mwanza
Catholic University of Health and Allied Sciences
Koy, Mheta
Tanzania, Mwanza
Catholic University of Health and Allied Sciences
Kataraihya, Johannes B.
Tanzania, Mwanza
Catholic University of Health and Allied Sciences
Jaka, Hyasinta M.
Tanzania, Mwanza
Catholic University of Health and Allied Sciences
Mshana, Stephen Eliatosha
Tanzania, Mwanza
Catholic University of Health and Allied Sciences
Mirambo, Mariam Mwinjuma
Tanzania, Mwanza
Catholic University of Health and Allied Sciences
McHembe, Mabula D.
Tanzania, Dar es Salaam
Muhimbili University of Health and Allied Sciences
Giiti, Geofrey Charles
Tanzania, Mwanza
Catholic University of Health and Allied Sciences
Gilyoma, Japhet M.
Tanzania, Mwanza
Catholic University of Health and Allied Sciences
Statistics
Citations: 94
Authors: 10
Affiliations: 2
Identifiers
Doi:
10.1186/1749-7922-7-4
e-ISSN:
17497922
Research Areas
Health System And Policy
Infectious Diseases
Study Design
Cohort Study
Study Approach
Quantitative
Study Locations
Tanzania
Participants Gender
Female