Pattern and Outcome of Typhoid Perforation in Benin City

Over a 26-year period, there were only twenty four cases of perforated typhoid that were operated at the University of Benin Teaching Hospital. Four cases had incomplete data and were excluded from the study and only twenty cases were therefore included in the study. Of the twenty patients, there were 12 males and 8 females and the age range was between 11 and 45 years, with a mean of 25.65 years. The main complaints were fever, abdominal pain, vomiting, diarrhea or constipation. Most of the patients presented late to the hospital. Most of the patients had single perforations. Simple closure was the method of treatment in most of the patients. Wound infection was the major post operation complication. The average hospital stay was 16.3 days. We conclude that compared with other tertiary health institutions in Nigeria, the incidence of typhoid perforation is low at the University of Benin Teaching Hospital, Benin City, Nigeria and simple closure of perforations is efficient in managing typhoid perforations. INTRODUCTION Typhoid fever is caused by Salmonella typhi, and acquired by ingestion of food or water contaminated with excreta from a patient with typhoid or from a carrier. Human beings are the only reservoirs of Salmonella typhi. Incidence of typhoid fever has been reduced in many countries by control of the faecal-oral transmission of the organisms. The disease continues to be a major health problem in developing countries. Gut perforation is the major complication with high morbidity and 1-3 mortality. The some of the reasons for the assoc ia ted compl ica t ions a re la te presentation and delay in making a diagnosis. There is often delay in making a diagnosis because of some other acute abdominal conditions which constitute differential 4 diagnosis of typhoid enteritis. Various patterns of presentation of t ypho id f eve r and i t s a s soc ia t ed complications have been reported from most centres in Africa. Communities without portable borne water are at a higher risk of the © CMS UNIBEN JMBR 2007 EDITION; VOL 6 (1& 2) disease. Poor personal hygiene is also another key factor in determining the incidence of typhoid fever. While some communities record low incidence of typhoid enteritis, others have higher incidence. The incidence of perforated typhoid is closely associated with the incidence of typhoid enteritis. In communities with a high incidence of typhoid enteritis, there is associated high 4,5 incidence of perforated typhoid. The purpose of this study is to present the pattern and outcome of typhoid perforation at the University of Benin Teaching Hospital over a 26 year period and to compare the findings with reports from other centres. MATERIALS AND METHODS The retrospective study which was carried out at the University of Benin Teaching Hospital (UBTH), covered between January 1980 and December 2005. UBTH is a tertiary health institution located in the centre of Benin City and caters for patients from Edo and other neighboring states in Nigeria. The case notes of patients that had surgery for perforated typhoid were retrieved and analysed for age, sex, symptoms on presentation, findings at operation and outcome of surgery. The main mode of management of patients with perforated typhoid at the University of Benin Teaching Hospital is laparotomy, simple closure of the perforation and peritoneal lavage. With regard to findings at operation, the number of perforations in the gut and the method of closure of the perforations were also analyzed. The average duration of onset of illness before presentation at the hospital was determined. The total number of days spent on admission was also analyzed. The morbidity and mortality were analyzed as well. Four case notes could not be obtained from the medical records and so were excluded from the study. The results are presented in simple tables. Pattern and Outcome of Typhoid Perforation in Benin City 14 © CMS UNIBEN JMBR 2007 EDITION; VOL 6 (1& 2) Table I: Features and outcome of management of patients with typhoid perforation S/N Sex Age (yrs)