Pattern of Presentation and Management of Typhoid Intestinal Perforation in Sagamu, South-West Nigeria: a 15 year Study

Background: Mortality from typhoid intestinal perforation remains high in the West African sub-region. The aim of this retrospective analysis was to assess the presentation pattern, mode of therapy and outcome of cases diagnosed and treated as typhoid intestinal perforation at Olabisi Onabanjo University Teaching Hospital, Sagamu, between January 1990 and December 2004. Methods: Complete records of 105 adult patients were studied. Results: The male to female ratio was 2:1. The mean age was 27years. Prior to arrival in our hospital, all the patients were on various combinations of antibiotics. Twenty-seven (26%) patients had been hospitalized elsewhere during the current illness. Chloramphenicol was the drug of first choice in the first ten years (phase 1). It was replaced with ciprofloxacin in the subsequent five years (phase 2). Blood culture was positive for salmonella organisms in 5(4%) patients. Resistance to chloramphenicol was found in three (60%) out of these five positive cultures. All patients had laparotomy after resuscitation. There were 112 perforations, mostly in the ileum and jejunum. Perforations were single in one hundred and one patients and multiple in four patients. Single perforations were treated by two-layered closure, multiple perforations by primary resection and anastomosis. Fifty-five (52.4%) patients developed complications. Fourteen (13.3%) patients died. There was a slight drop in mortality (8.8 %) in phase 2. Deaths were due to septicaemia in 8(57%) patients. Conclusion: The pattern of presentation and outcome of management of typhoid intestinal perforation are similar to what is observed in other centres in our local environment. However the drop in mortality rate in the last 5 years of the study and the finding of strains of salmonella typhi resistant to chloramphenicol require further evaluation. Keywords: typhoid intestinal perforation, ciprofloxacin, chloramphenicol, operative management.Nigerian Journal of Medicine Vol. 17 (4) 2008: pp. 387-39