Typhoid intestinal perforation under 5 years of age

Background: Typhoid intestinal perforation is an important cause of morbidity and mortality in many developing countries. The peculiar features in children < 5 years old need to be recognised in order to improve outcome. Objective: To determine the characteristic pattern and outcome of typhoid intestinal perforation in children under 5 years of age in south-east Nigeria. Method: Comparative analysis of 83 children with typhoid intestinal perforation between January 2001 and December 2006 at the University of Nigeria Teaching Hospital, Enugu. Results: There were 22 (26.5%) children < 5 years of age and 61 (73.5%) > 5 years. In the younger children, the predominant presentation was fever, vomiting and abdominal tenderness, and in the older children it was fever, abdominal pain and distension. Features of peritonitis were present in only 54.5% aged <5 years compared with 90.2% of the older children (p < 0.001). The average number of perforations in the under-5s was 2.1 (range 1-4) and > 1.3 (range 1-3) in the older children (p < 0.01). The types of operative procedure (simple closure and segmental bowel resection) were similar in both groups. Post-operative complications were not significantly different in the two groups and included surgical wound infection, prolonged ileus, pulmonary infection, wound dehiscence, re-perforation, intra-abdominal abscess and incisional hernia. There were nine (40.9%) deaths in the < 5s and 12 (19.7%) in the > 5s (p < 0.05). Conclusion: Typhoid intestinal perforation in children < 5 is associated with atypical presentation and high mortality. A high index of suspicion will ensure earlier presentation and might improve outcome.