Typhoid perforations at the teaching hospital Gabriel-Touré of Bamako (Mali)

The typhoid perforations remain a frequent cause of peritonitis in the developing countries. The aims of this study were to determine the frequency of hospital visit, describe the clinical and paraclinical signs, and analyze the complications after surgery, during 10 years (January 1999-December 2008), in the service of general and pediatric surgery at the Gabriel-Touré teaching hospital. The study involved all the patients operated for peritonitis due to typhoid perforation (385 cases, i.e., 32.5% of all peritonitis). There were 136 women (35.4%) and 249 men (64.6%), and the mean age was 15.2 ± 11.6 years (2-65 years). Two hundred and fifty patients (64.93%) were between 2 and 15 years, and 64 patients (16.62%) had been treated already for typhoid fever. The average of hospital stay was 18.4 days (DS = 6.5). The radiography of the abdomen without preparation was carried out in 221 patients and had a sensitivity of 70.59%; the sensitivity of Widal was 82%. The perforated bodies were the following: ileum 367 (95.32%), colon 9 (2.34%), and gall bladder 9 (2.34%). The excision closure was carried out 273 times, 44 resections with anastomosis in first time, 54 ileostomies, 9 cholecystectomies, and 5 right colectomies with ileostomies. Mortality was 8.33%, and the morbidity was 21.56% (61 wound infections, 8 digestive fistulas, 7 peritonitis, and 7 eviscerations). The follow-ups were not influenced by the procedure. Conclusion: The typhoid perforations remain the second cause of peritonitis at the Gabriel-Touré teaching hospital. The complications after surgery are frequent and serious. It is necessary to set up an effective method for prevention of the typhoid fever. © 2009 Springer Verlag France.