Association of Surgeons of East Africa and College of Surgeons of East Central and Southern Africa
Doi
Abstract
Background: Despite decades of improvement in patient care globally,
typhoid intestinal perforation remains a frequently fatal illness in
the developing world. This study aimed at determining the factors that
influenced the outcome of surgical management typhoid intestinal
perforation in Sagamu, South-West Nigeria. Methods: Twenty-three
consecutive adult cases managed between January 2006 and December 2008
at the surgical department of Olabisi Onabanjo University Teaching
Hospital Sagamu were studied prospectively. Patients received parental
ciprofloxacin or ceftriaxone in addition to metronidazole. They all had
laparotomy after adequate resuscitation. Patients in American Society
of Anesthesiologists (ASA) class VE were operated upon under local
anaesthesia, intravenous ketamine and diazepam. Results: There were 13
males and 10 females with a male to female sex ratio of 1.3:1. The ages
ranged from 19 to 51 years. Seventeen (73.9%) patients were aged
between 20 and 34 years. Two patients, one each from ASA grades IVE and
VE, died on 1st and 2nd postoperative days respectively. The mortality
of 8.7% was significantly associated with ASA class (P= 0.040). ASA
class was strongly associated with severity of peritonitis (P=0.021).
Complications occurred in 11 (47.8%) patients. Ten (43.5%) developed
wound infection and one (4.3%) an entercutaenous fecal fistula. Wound
infection was significantly associated with method of closure of
perforation (P=0.034), and number of perforations (P=0.007).
Conclusion: This study has shown that ASA class is a significant
predictor of mortality in patients treated for typhoid intestinal
perforation in our centre. We recommend that patients in ASA classes IV
and V should have post-operative intensive care to reduce the risk of
death
