Outcome of primary closure of abdominal wounds following typhoid perforation in children in Ile-Ife, Nigeria

Abstract

Background: Abdominal wounds following surgery for typhoid perforation are classifi ed as dirty, with an infection rate of over 40%. To date, the optimal method for closure of these wounds remains controversial. Delayed primary closure which was conventionally recommended as standard practice, is now considered to be of no value in preventing surgical site infection (SSI). This study evaluates the outcome of primary closure of this class of wounds in children in Ile-Ife, Nigeria, and advocates a multidisciplinary wound management protocol. Patients and Methods: This is a retrospective study of children aged < 1–15 years who had had surgery for typhoid perforation in a teaching hospital in south western Nigeria, over a period of ten years. Results: Thirty-two patients, 18 males and 14 females, in the ratio of 1.3:1 were managed for typhoid perforation during the ten year period. All 32 patients had primary closure of their abdominal wounds. There was primary wound healing in six (18.8%) patients, while 19 (59.4%) patients had surgical site infections. Wound dehiscence, intraabdominal abscess, and faecal fi stulas were the other complications documented in the study. Conclusion: Abdominal wounds of typhoid perforation, though classifi ed as being dirty, can be closed primarily with good healing outcomes. A multidisciplinary approach to wound management will reduce the incidence of wound sepsis and its associated morbidity and costs. Keywords: Children, outcome of primary closure of abdominal wounds, typhoid perforationAfrican Journal of Paediatric Surgery Vol. 6 (1) 2009: pp. 31-3