M. Cheung1, J. M. Healy1, N. Kakembo2, A. Muzira2, P. Kisa2, J. Sekabira2, D. Ozgediz1 1Yale University School Of Medicine,Surgery,New Haven, CT, USA 2Mulago Hospital, Makerere University,Surgery,Kampala, , Uganda
Introduction: Typhoid ileal perforation comprises a substantial pediatric surgical burden in low-income countries, while in high-income countries it is rarely encountered and the mortality rate negligible. Mortality rates are 10-20-fold higher in low-income countries where surgical treatment ranges from repair of intestinal perforation to diverting enterostomy and interval ostomy reversal. There has been no prior analysis of pediatric typhoid perforation epidemiology and outcomes in Uganda despite the significant socioeconomic impact on these children and families.
Methods: Review of a prospectively collected database of 3,289 pediatric surgical admissions to a tertiary referral hospital in Uganda from January 2012 to March 2016.
Results: 95 cases were identified: 79 new cases and 16 patients presenting for ostomy reversal (excluded). The majority underwent operations (94.9%) with 56 (75%) requiring ostomy creation. Median age was 8 years with a range of 2-12 years. Median distance traveled was 30 km with a range of 4-450 km, and duration of hospitalization ranged from 1–44 days, with a median of 9 days. Geospatial mapping showed a majority of cases from the south central and west of the country (Figure 1). Post-operative courses ranged from 1–38 days with a median of 6 days. Overall mortality was 19.0%.
Conclusion: Typhoid perforation preferentially affects vulnerable populations in low-income countries, and in Uganda a similar demographic is affected. Distance travelled approached the recommended 50 km set by the World Health Organization. While repair of perforation has been described, 75% of these children required diversion, suggesting more severe disease at presentation, and in Uganda ostomy creation has been associated with social isolation and impoverishment. The 19% case fatality rate is comparable to similar settings and underscores disease severity. More hospital and community-based data are needed for a more accurate national geospatial disease profile. This disease presents an opportunity for the global pediatric surgery community to promote disease prevention and access to emergency children’s surgical care in resource-poor areas.
