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Surgical Complications of Typhoid Fever 109
Table 17.3: Evidence-based research.

Title Typhoid colonic perforation in childhood: a ten-year
experience
Authors Chang Y-T, Lin J-Y, Huang Y-S
Institution Division of Pediatric Surgery, Department of Surgery,
Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
Reference World J Surg 2006; 30:242–247
Problem The ideal treatment of typhoid colonic perforation in children.
Intervention Three different ways of surgical management of typhoid
colonic perforations in children.
Comparison/ Compares three methods of surgically treating typhoid colonic
control perforations in children: primary closure of the perforation with
(quality of ileostomy, wedge resection and simple closure, and partial
colectomy with colostomy.
evidence)
Outcome/ One hundred percent survival rates, mainly attributed to the
effect institution of total parenteral nutrition (TPN) after sufficient
hydration. Another outcome measure was length of hospital
stay (LOS), which was shorter for the wedge resection and
simple closure group than for the others. Complications were
similar to those seen in cases of typhoid ileal perforations.
Historical Typhoid colonic perforation is rare in the authors’ subregion, but
significance/ it does occur. Paediatric surgeons should be suspicious when
comments the ileum is inspected for perforations and none are found, and
should inspect the colon. The small size of the sample in the
study notwithstanding, useful lessons are to be learned from it,
especially the use of TPN to keep the patients nourished until
normal bowel movement is fully recovered, which can definitely
play a major role in the survival of patients.

Key Summary Points
1. Diagnosis of typhoid intestinal perforation (TIP) is mostly clinical. 5. Eliminate continuous peritoneal contamination by surgery.
Plain erect/supine abdominal x-rays and/or chest x-ray may show Simple closure or segmental resection and anastomosis are
pneumoperitoneum in about 75% of patients. effective. If the child is too ill, exteriorise the segment of bowel
2. Most patients are very ill, anaemic, hypoproteinaemic, with the perforation as an ileostomy. Thorough peritoneal lavage/
malnourished, and may have toxic myocarditis. Prepare them toileting with copious amounts of normal saline is mandatory.
well before surgery. 6. Strictly monitor input/output for all children with TIP and at least
3. Most patients have fluid and electrolyte imbalance. Initial repeat the haemogram and electrolytes 48 hours after surgery
electrolytes may be normal, but repeat check after resuscitation, and correct any derangements.
as they often become deranged by then. Check electrolytes 7. Use total parenteral nutrition (TPN) where available, but
(esp. K , Na , and Cl ) in all patients and correct imbalances convert to enteral feeding as soon as practicable.
+
−
+
before surgery.
8. Reassess the child daily to identify any postoperative
4. Give appropriate antibiotics that are effective against complications and deal with them as soon as feasible.
Salmonella typhi and anaerobes (usually, a minimum of two
antibiotics) and analgesics.

References

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of typhoid fever in five Asian countries: disease burden and perforation in Ghana: a five-year retrospective study. Trop Doct
implication for controls. Bull World Hlth Org 2008; 86:260–268. 2007; 37:231–233.
2. World Health Organization. Typhoid vaccines: WHO position 7. Meier DE, Tarpley JL. Typhoid intestinal perforation in Nigerian
paper. Weekly Epidemiol Rec No. 6, 2008; 83:49–60. children. World J Surg 1998; 22:319–323.
3. Ekenze SO, Ikefuna AN. Typhoid perforation under 5 years of age. 8. Mahle WT, Levine MM. Salmonella typhi infection in children
Ann Trop Paediatr 2008; 28:53–58. younger than 5 years of age. Pediatr Infect Dis 1993; 12:627–637.
4. Abantanga FA, Wiafe-Addai B. Postoperative complications after 9. Chang Y-T, Lin J-Y, Huang Y-S. Typhoid colonic perforation in
surgery for typhoid perforation in children in Ghana. Pediatr Surg childhood: a ten-year experience. World J Surg 2006; 30:242–247.
Int 1998; 14:55–58.
10. Drossou-Agakidou V, Roilides E, Papakyriakidou-Koliouska P, et
5. Ameh EA. Typhoid ileal perforation in children: a scourge in al. Use of ciprofloxacin in neonatal sepsis: lack of adverse effects
developing countries. Ann Trop Paediatr 1999; 19:267–272. up to one year. Pediatr Infect Dis J 2004; 23:346–349.