Typhoid Intestinal Disease: Management of Patients With Multiple Perforations

Background: To review the management given to patients with multiple ileal and/or colonic perforations from typhoid intestinal disease over a 5-year period. Patients and Methods: All patients who had more than one ileal perforation or had one or more colonic perforations from typhoid disease from January 2001 to December 2005 were retrospectively reviewed. Patient's age, site and number of perforations, pre, -and intra-operative management, and postoperative complications were retrieved from patients case notes. Results: Twenty-seven patients (15 males, 12 females) had multiple perforations during the study period. The age range was 4- 14 years (mean 9.2years). Twelve patients had 2 perforations, 3 patients had 3, 3 patients had 4 perforations, one patient each had 14, 27 and 32 perforations. Seventeen patients had trimming of the ulcer edges and simple double layer closure, 2 had segmental resection and 8 had right hemicolectomy. The wounds of 5 patients healed primarily, 15 had superficial wound infection, 4 had wound dehiscence, 3 had faecal fistula. Three patients died as a result of late presentation and septicaemia. Conclusion: There appears to be a rise in multiple ileal and/ or colonic perforations caused by typhoid enteritis poses. Early referral to tertiary health institutions, adequate resuscitation, prompt operative intervention and close post operative management will decrease morbidity and mortality