Repeat Laparotomy in Typhoid Intestinal Perforation Patients: Experience from a Developing Nation
Journal Title: Scholars Journal of Applied Medical Sciences - Year 2015, Vol 3, Issue 1
Abstract
Typhoid intestinal perforation constitutes one of the major indications for admission into emergency unit in areas of low socio economic environment. Its associated with many post operative complications, some requiring repeat laparotomy. Study was carried out to review of all cases of TIP between 2003 and 2011 in two hospitals (LTH &AMC both in Osogbo). The case files of 216 out of 235 patients treated for TIP between 2003 to 2011 at the study centres were evaluated. This consisted of 63.5% males and 80% in the first two decade of life. There were 24 RL in 21 (9.99%) patients, all the in the first 2 decades but significantly higher in the first decade (p-value= 0.0009) and patients with serum urea greater than 10 mmol/l (p=0.0000, RR 3.67), PCV less than 20% (p= 0.0000, RR 21) and those presenting after 5 days after perforation ( p= 0.000)but not with jaundice (p= 0.3967, RR 3.01. Perforations closer to the ICJ( >5cm) (p=0.0266), faeculent or frank intra abdominal pus collection (p = 0.037 , RR = 2.3) significantly predispose to RL ( x2= 4.9123,), but no significant difference in the incidence of those with 1 or 2 intestinal perforations compared to those with 3 or 4 .( x2=0.03, p= 0.862). Indications were intra abdominal abscess, wound or anastomotic dehiscence, re- perforation, adhesive obstruction and persistent entero-cutaneous fistula. The mean LOS is significantly prolong and mortality significantly higher (X2=9.454, p value 0.0006) in those with RL. Late presentation, anaemia, renal impairment, perforations in the high pressure zone predisposes to RL which worsens prognosis and prolongs hospital stay in patients with TIP.
Authors and Affiliations
Oguntola Adetunji Saliu, Akanbi Olusola, Adeoti Moses Layiwola, Aderounmu Atilola O. Adebimpe, Idris O. Lateef
Keywords
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