Typhoid ileal perforation in Shisong, Northwestern Cameroon

Abstract

Background: The study aims to provide an overview of the spectrum of perforated typhoid fever cases and their outcome that were managed in resource constrained rural mission hospital, Northwestern of Cameroon. Methods: This was a retrospective observational study which was conducted in St Elizabeth Catholic General Hospital, Shisong, Northwestern region of Cameroon over a two year period covering January 2016 and December 2018. The patients included were those admitted and diagnosed of typhoid ileal perforation. Data collected were analyzed using SPSS computer software version 22. Results: During the study period, thirty-eight patients underwent surgery for typhoid ileal perforation. They included 26 (68.43%) males and 12 (31.57%) females with Male to Female ratio of 2.2: 1. Sixty -five percent of cases occurred between the months of July and September. The most common presentations were with abdominal pains (92.11%), and abdominal distention (92.11%). X-ray abdomen revealed pneumo -peritoneum in 26 (68.4%) cases, while ultrasound detected free peritoneal collection in 34 (90%) cases. Perforations were surgically treated depending upon the number of perforations, general health status of patient and degree of fecal contamination. Perforated typhoid still carries dismal prognosis. The mortality was associated with duration of delay in obtaining blood pre - operatively for patients requiring transfusion (p=0.018) and duration of presentation to operation time interval (p=0.026). Conclusion: Typhoid intestinal perforation is still endemic in our setting with dismal prognosis. Urgent public health concerted effort is required with emphasis on preventive measures such as safe drinking water, appropriate sewage disposal, and typhoid vaccination. Educating the populace on early and prompt diagnosis, adequate resuscitation as well as early surgery in patients with typhoid ileal perforation to keep the mortality low.