Prognostic Factors Of Typhoid Perforation in Lagos

Perforation of the ileum remains one of the commonest and the most dramatic complication of Typhoid fever in developing countries where the infection is still prevalent. A prospective study of patients with typhoid perforation seen at the Lagos University Teaching Hospital was carried out over a 6-year period. There were 78 consecutive patients, the majority (80.7%) of whom were within the age range of 11 and 30 years (mean 20.9 +SD 11.2 years) and were mostly (65.4%) students. All patients were managed using the standard procedure of prompt surgical intervention after adequate resuscitation. The mean of the period of resuscitation was 20.10 + SD 9.3 hours. The case fatality rate of 12.8% and the mean period of hospitalisation for survivors was 21.1 + 11.7 days. The study showed that high serum urea levels, acidosis, presence of jaundice and very large amount of peritoneal fluid (above 1 litre) were associated with poor prognosis. However, there was no statistically significant difference (P > 0.05) between survivors and non-survivors as regards the age, sex, temperature at presentation, pulse rate, serum Na+, serum K+ and both the site and number of ileal perforations. It is concluded that patients with typhoid perforation need to present early because in spite of appropriate intervention, most of those who are jaundiced, uraemic or acidotic carry poor prognosis and should be ideally managed in an intensive care setting. Nigerian Quarterly Journal of Hospital Medicine Vol. 9, No. 1 (1999) pp. 78-8