Typhoid fever perforation in Kathmandu, Nepal

Introduction: Typhoid fever is a global health problem, causing significant morbidity and mortality throughout the developing world. A recent survey estimated a global number of 21.7 million illnesses and 217.000 deaths in the year 2000. Due to poverty and poor sanitary conditions, typhoid fever remains a major health problem in Nepal. A frequent complication of typhoid fever is perforation of the terminal ileum. Mortality rates rating from 20 40 % are most commonly reported. Aims and objectives The aim of this study was to trace risk factors for enteric perforation in patients with typhoid fever as well as to assess health care factors that influence the outcome of these patients. Methods and materials This retrospective study was conducted at the Tribhuvan University Teaching Hospital in Kathmandu, Nepal. The inclusion criteria for participation was the diagnosis ileal perforation due to typhoid fever in adult patients (≥ 16 years). During June 14th 2006 and May 22th 2010, 30 patients underwent surgery for ileal perforation due to typhoid fever and were therefore enrolled in the study. Using a collection form, data was abstracted from the medical records of these patients and then analyzed. Results There were 22 males and eight females (male : female ratio 2.75 : 1) with a mean age of 28.1 ± 10.0 years. The mean duration of symtoms was 14 ± 11.0 days (range 5 60 days) and all patients suffered from fever and abdominal pain. A majority (16) of the perforations occured in the second week of disease. Primary repair was applied to 18 patients, while 11 patients received wedge resection and one patient received ileostomy. Reperforation occured in one patient and mortality developed in two (7 %) patients. Conclusions Typhoid fever remains a major health problem in Nepal. The leading cause of mortality in typhoid fever is ileal perforation, which is a complication that possibly could be prevented. Identification and appropriate antibiotic treatment of typhoid fever would reduce morbidity and mortality. Early and appropriate surgical intervention is vital for the survival of typhoid fever perforation.