Profile of Abdominal Surgical Complications of Enteric Fever in Children in a Developing Country


Background: Surgical complications of enteric fever has been associated with significant morbidity and mortality. The aim of this study was to determine the pattern and outcome of the treatment of abdominal surgical complications of enteric fever in children in a teaching hospital in Enugu, Nigeria.

Methods: This retrospective study included children who had undergone a surgery for abdominal complications of enteric fever at the pediatric surgery unit of Enugu State University Teaching Hospital (ESUTH), Enugu, Nigeria. The medical records of the pediatric patients over a five-year period were evaluated for the patients’ demographics, presenting symptoms, investigations, intraoperative findings, procedures performed, and postoperative complications and outcome.

Results: During the study period, there were 44 cases of abdominal surgical complications of enteric fever with an age range of 6–14 years (mean 9.5 years) and the male to female ratio of 2.7:1. The mean duration of symptoms prior to presentation was five days. All the patients had fever and abdominal pain. While 95% of the patient had typhoid intestinal perforation, 5% had typhoid hemorrhage. Primary closure of intestinal perforation and right hemicolectomy with ileotransverse anastomosis were performed for typhoid intestinal perforation and typhoid intestinal hemorrhage, respectively. Surgical site infection was the most common postoperative complication. The mortality rate was 6.8%.

Conclusion: Abdominal surgical complications of enteric fever are still obtainable in developing countries. Typhoid intestinal perforation was the most common complication recorded in the present study.

Keywords: abdominal, children, enteric fever, surgical complications

1) Archampong EQ, Tandoh JF, Nwako FA, Badoe EA, Foli AK, Akande B. Surgical problems of enteric fever. In: Badoe EA, Archampong EQ, Jaja MO, editors. Principles and Practice of Surgery including Pathology in the Tropics. 2nd edition. Ghana: Ghana publishing corporation; 1994. p. 602-4.
2) Ochiai RL, Acosta CJ, Danovaro-Holliday MC, Baiqing D, Bhattacharya SK, Agtini MD. A study of typhoid fever in five Asian countries: disease burden and implications for controls. Bull World Health Organ. 2008; 86: 260-268.
3) Parry CM, Hien TT, Dougan G, White NJ, Farrar JJ. Typhoid fever. N Engl J Med. 2002; 347: 1770-1782.
4) Bitar R, Tarpley J. Intestinal perforation in typhoid fever: a historical and state-of-the-art review. Rev Infant Dis. 1985; 7: 257-271.
5) Ekenze SO, Ikefuna AN. Typhoid Intestinal Perforation Under 5 Years of Age. Ann Trop Paediatr. 2008; 28: 53-8. doi: 10.1179/146532808X270680
6) Ameh EA. Typhoid ileal perforation in Nigerian children: A scourge in developing countries. Ann Trop Paediatr. 1999; 19: 267-73.
7) Lucas AO, Gilles HM. Communicable diseases: Infections through the gastrointestinal tract. In: Lucas AO, Gilles HM, editors. Short Textbook of Public Health Medicine for the Tropics. 4th rev ed. London: Arnold Publishers; 2003. p. 59.
8) Ezzat RF, Hussein HA, Baban TS, Rashid AT, Abdullah KM. Typhoid ulcer causing life-threatening bleeding from Dieulafoy’s lesion of the ileum in a seven-year-old child: a case report. J Med Case Rep. 2010; 4: 171. doi: 10.1186/1752-1947-4-171.
9) Osifo OD, Ogiemwonyi SO. Typhoid ileal perforation in children in Benin city. Afr J Paediatr Surg. 2010; 7: 96-100.
10) Uba AF, Chirdan LB, Ituen AM, Mohammed AM. Typhoid intestinal perforation in children: a continuing scourge in a developing country. Pediatr Surg Int. 2007; 23: 33-39. doi: 10.1007/s00383-006-1796-3
11) Olori S, Ukpoju E. Typhoid ileal perforation in children: does clinical diagnosis alone justify laparotomy? South Sudan Medical Journal. 2019; 12: 9-11.
12) Edino ST, Yakubu AA, Mohammed AZ, Abubakar IS. Prognostic factors in typhoid ileal perforation, a prospective study of 53 cases. J Natl Med Assoc. 2007; 99: 1042-5.
13) Khan M. A plausible explanation for male dominance in typhoid ileal perforation. Clin Exp Gastroenterol. 2012; 5: 213-217. doi: 10.2147/CEG.S36569
14) Sheshe AA, Anyanwu LJC, Mohammed AM, Mohammad AB, Obaro SK. Typhoid intestinal perforation: Analysis of the outcome of surgical treatment in Kano, Nigeria. Arch Med Health Sci. 2018; 6: 59-63.
15) Milligan R, Paul M, Richardson M, Neuberger A. Vaccines for preventing typhoid fever. Cochrane Database Syst Rev. 2018; 5(5): CD001261. doi: 10.1002/14651858.CD001261.pub4.
16) Ekenze SO, Okoro PE, Amah CC, Ezike HA, Ikefuna AN. Typhoid ileal perforation: analysis of morbidity and mortality in 89 children. Niger J Clin Pract. 2008; 11: 58-62.
17) Usang EU, Inyang AW, Nwachukwu IE, Emehute JC. Typhoid perforation in children: an unrelenting plaque in developing countries. J Infect Dev Ctries. 2017; 11: 747-752. doi: 10.3855/jidc.9304
18) Jemni L, Mehdi A, Chakroun M, Chatti N, Djaidane A. Complications of typhoid fever. Med Trop (Mars), 1989; 49: 189-191.
19) Lee JH, Kim JJ, Jung JH, Lee SY, Bae MH, Kim YH, Son HJ, Rhee PL, Rhee JC. Colonoscopic manifestations of typhoid fever with lower gastrointestinal bleeding. Dig Liver Dis. 2004; 36(2): 141-146.
20) Chalya PL, Mabula JB, Koy M, Kataraihya JB, Jaka H, Mshana SE. Typhoid intestinal perforations at a University teaching hospital in Northwestern Tanzania: A surgical experience of 104 cases in a resource-limited setting. World J Emerg Surg. 2012; 7: 4. doi: 10.1186/1749-7922-7-4
21) Ugochukwu AI, Amu OC, Nzegwu MA. Ileal perforation due to typhoid fever-Review of operative management and outcome in an urban centre in Nigeria. Int J Surg. 2013; 11: 218-222. doi: 10.1016/j.ijsu.2013.01.014.
22) Mateen MA, Saleem S, Rao PC, Reddy PS, Reddy DN. Ultrasound in the diagnosis of typhoid fever. Indian J Pediatr. 2006; 73(8): 681-685. doi: 10.1007/bf02898444.
23) Contini S. Typhoid intestinal perforation in developing countries: Still unavoidable deaths? World J Gastroenterol. 2017; 23: 1925-1931. doi: 10.3748/wjg.v23.i11.1925.
24) Sharma AK, Sharma RK, Sharma SK, Sharma A, Soni D. Typhoid Intestinal Perforation: 24 Perforations in One Patient. Ann Med Health Sci Res. 2013; 3(Suppl1): S41-S43. doi: 10.4103/2141-9248.121220
25) Chaudhary P, Kumar R, Munjewar C, Bhadana U, Ranjan G, Gupta S, Kumar S, Arora MP. Typhoid ileal perforation: a 13-year experience. Healthcare in Low-resource Settings. 2015; 3: 4677. doi: 10.4081/hls.2015.4677.
26) Vagholkar K, Mirani J, Jain U, Iyengar M, Chavan RK. Abdominal Complications of Typhoid Fever. Journal of Surgery. 2015; 10(4): 227-338. doi: 10.7438/1584-9341-10-4-9.
27) Goel A, Bansal R. Massive Lower Gastrointestinal Bleed caused by Typhoid Ulcer: Conservative Management. Eurosian J Hepatogastroenterol. 2017; 7(2): 176-177. doi: 10.5005/jp-journals-10018-1242.