全部 标题 作者
关键词 摘要

OALib Journal期刊
ISSN: 2333-9721
费用:99美元

查看量下载量

相关文章

更多...

Clinical Epidemiology and Surgical Treatment of Spontaneous Perforations of the Terminal Ileum: A Multicentre Study in Cameroon

DOI: 10.4236/ss.2024.155029, PP. 311-320

Keywords: Perforation of the Terminal Ileum, Simple Suture, Resection, Morbidity, Mortality

Full-Text   Cite this paper   Add to My Lib

Abstract:

Background: Perforations of the terminal ileum are a frequent clinical situation and a therapeutic challenge. Surgical treatment is controversial. Several surgical modalities have been proposed and postoperative morbidity and mortality remain high. The aim of this study was to review our experience in the surgical management of perforations of the terminal ileum. Patients and methods: This is a descriptive cross-sectional study with retrospective data collection from January 1, 2017 to December 31, 2021, in five hospitals in Cameroon. Patients’ demographic, clinical presentation, surgical findings and 30-days postoperative outcomes data were collected. Results: We collected 34 files. The sex ratio was 1.4 and the average age was 20.28 years. The average consultation time was 9.1 days. Abdominal pain was present in all our patients. Peritoneal irritation was present in 46 cases (88.5%). The mean time to treatment after admission was 17.5 hours. The perforation was unique in 40 cases (76.9%) and located between 6 and 10 cm from the ileocecal valve in 29 cases (55.8%). Typhoid was the most suspected etiology intraoperatively in 38 cases (73.1%). A simple suture was performed in 18 patients (34.6%), resection with anastomosis in 11 patients (21.2%) and an ileostomy in 5 patients (9.6%). The average length of hospitalization was 21.74 days. Postoperative morbidity and mortality were 32.7% and 17.3% respectively. Conclusion: Perforations of the terminal ileum are common and affect young people. Surgical procedures are varied. Reducing consultation and care times and respecting treatment principles could improve postoperative morbidity and mortality, which remain high.

References

[1]  Qazi, S.H., Yousafzai, M.T., Saddal, N.S., Dehraj, I.F., Thobani, R.S., Akhtar, A., et al. (2020) Burden of Ileal Perforations among Surgical Patients Admitted in Tertiary Care Hospitals of Three Asian Countries: Surveillance of Enteric Fever in Asia Project (SEAP), September 2016-September 2019. Clinical Infectious Diseases, 71, S232-S238.
https://doi.org/10.1093/cid/ciaa1309
[2]  Wani, R.A., Parray, F.Q., Bhat, N.A., Wani, M.A., Bhat, T.H. and Farzana, F. (2006) Nontraumatic Terminal Ileal Perforation. World Journal of Emergency Surgery, 1, Article No. 7.
https://doi.org/10.1186/1749-7922-1-7
[3]  Babu, R.G., Malolan, A. and Chowdary, P.B. (2016) Ileostomy for Non-Traumatic Ileal Perforations: Is This the Beginning of the End? Journal of Clinical and Diagnostic Research, 10, 23-26.
https://doi.org/10.7860/JCDR/2016/18461.7473
[4]  Ukwenya, A.Y., Ahmed, A. and Garba, E.S. (2011) Progress in Management of Typhoid Perforation. Annals of African Medicine, 10, 259-265.
https://doi.org/10.4103/1596-3519.87040
[5]  Nuhu, A., Dahwa, S. and Hamza, A. (2010) Operative Management of Typhoid Ileal Perforation in Children. African Journal of Paediatric Surgery, 7, 9-13.
https://doi.org/10.4103/0189-6725.59351
[6]  Santillana, M. (1991) Surgical Complications of Typhoid Fever: Enteric Perforation. World Journal of Surgery, 15, 170-175.
https://doi.org/10.1007/BF01659050
[7]  Akgun, Y., Bac, B., Boylu, S., Aban, N. and Tacyildiz, I. (1995) Typhoid Enteric Perforation. British Journal of Surgery, 82, 1512-1515.
https://doi.org/10.1002/bjs.1800821120
[8]  Abantanga, F.A. and Wiafe-Addai, B.B. (1998) Postoperative Complications after Surgery for Typhoid Perforation in Children in Ghana. Pediatric Surgery International, 14, 55-58.
https://doi.org/10.1007/s003830050435
[9]  Pujar, K.A., Ashok, C.A., Rudresh, H.K., Srikantaiah, H.C., Girish, K.S. and Suhas, K.R. (2013) Mortality in Typhoid Intestinal Perforation—A Declining Trend. Journal of Clinical and Diagnostic Research, 7, 1946-1948.
[10]  Saxe, J.M. and Cropsey, R. (2005) Is Operative Management Effective in Treatment of Perforated Typhoid? The American Journal of Surgery, 189, 342-344.
https://doi.org/10.1016/j.amjsurg.2004.11.032
[11]  Adeniran, J.O., Taiwo, J.O. and Abdur-Rahman, L.O. (2005) Salmonella Intestinal Perforation: (27 Perforations in One Patient, 14 Perforations in Another). Are the Goal Posts Changing? Journal of Indian Association of Pediatric Surgeons, 10, 248-251.
https://doi.org/10.4103/0971-9261.19275
[12]  Edino, S.T., Yakubu, A.A., Mohammed, A.Z. and Abubakar, I.S. (2007) Prognostic Factors in Typhoid Ileal Perforation: A Prospective Study of 53 Cases. Journal of the National Medical Association, 99, 1042-1045.
[13]  Ajao, O.G. (1982) Typhoid Perforation: Factors Affecting Mortality & Morbidity. International Surgery, 67, 317-319.
[14]  Kambire, J.L., Ouedraogo, S., Ouedraogo, S., Ouangre, E. and Traore, S.S. (2017) Résultats de la prise en charge des perforations iléales typhiques: À propos de 29 cas à Ouahigouya (Burkina Faso). Bulletin de la Société de Pathologie Exotique, 110, 298-299.
https://doi.org/10.1007/s13149-017-0579-5
[15]  Ouedraogo, S., Ouangre, E. and Zida, M. (2017) Profils épidémiologiques, cliniques et thérapeutiques des perforations iléales d’origine typhique en milieu rural burkinabé. Médecine et Santé Tropicales, 27, 67-70.
https://doi.org/10.1684/mst.2017.0661
[16]  Njarekkattuvalappil, S.K., Thomas, M., Kapil, A., Saigal, K., Ray, P., Anandan, S., et al. (2021) Ileal Perforation and Enteric Fever: Implications for Burden of Disease Estimation. The Journal of Infectious Diseases, 224, S522-S528.
https://doi.org/10.1093/infdis/jiab258
[17]  Gedik, E., Girgin, S., Taçyildiz, I.H. and Akgün, Y. (2008) Risk Factors Affecting Morbidity in Typhoid Enteric Perforation. Langenbecks Archives of Surgery, 393, 973-977.
https://doi.org/10.1007/s00423-007-0244-8
[18]  Ugochukwu, A.I., Amu, O.C. and Nzegwu, M.A. (2013) Ileal Perforation Due to Typhoid Fever—Review of Operative Management and Outcome in an Urban Centre in Nigeria. International Journal of Surgery, 11, 218-222.
https://doi.org/10.1016/j.ijsu.2013.01.014
[19]  Husain, M., Khan, R.N., Rehmani, B. and Haris, H. (2011) Omental Patch Technique for the Ileal Perforation Secondary to Typhoid Fever. Saudi Journal of Gastroenterology, 17, 208-211.
https://doi.org/10.4103/1319-3767.80386
[20]  Olgemoeller, F., Waluza, J.J., Zeka, D., Gauld, J.S., Diggle, P.J., Read, J.M., et al. (2020) Intestinal Perforations Associated with a High Mortality and Frequent Complications during an Epidemic of Multidrug-Resistant Typhoid Fever in Blantyre, Malawi. Clinical Infectious Diseases, 71, S96-S101.
https://doi.org/10.1093/cid/ciaa405
[21]  Poornima, R., Venkatesh, K.L., Goutham, M.V. and Hassan, N. (2017) Clinicopathological Study of Ileal Perforation: Study in Tertiary Center. International Surgery Journal, 4, 543-549.
https://doi.org/10.18203/2349-2902.isj20164796
[22]  Khalid, S., Burhanulhuq and Bhatti, A.A. (2014) Non-Traumatic Spontaneous Ileal Perforation: Experience with 125 Cases. Journal of Ayub Medical College, Abbottabad, 26, 526-529.
[23]  Ameh, E.A., Dogo, P.M., Attah, M.M. and Nmadu, P.T. (1997) Comparison of Three Operations for Typhoid Perforation. British Journal of Surgery, 84, 558-559.
https://doi.org/10.1046/j.1365-2168.1997.t01-1-02494.x
[24]  Athie, C.G., Guizar, C.B., Alcantara, A.V., Alcaraz, G.H. and Montalvo, E.J. (1998) Twenty-Five Years of Experience in the Surgical Treatment of Perforation of Ileum by Salmonella typhi at the General Hospital of Mexico City, Mexico. Surgery, 123, 632-636.
https://doi.org/10.1016/S0039-6060(98)70201-6
[25]  Atamanalp, S.S., Aydinli, B., Ozturk, G., Oren, D., Basoglu, M. and Yilirgan, M.I. (2007) Typhoid Intestinal Perforations: Twenty-Six Year Experience. World Journal of Surgery, 31, 1883-1888.
https://doi.org/10.1007/s00268-007-9141-0

Full-Text

Contact Us

service@oalib.com

QQ:3279437679

WhatsApp +8615387084133