CHAPTER 1

1.0. INTRODUCTION

Typhoid fever, a severe febrile illness caused primarily by the gram-negative

bacillus Salmonella typhi, has continued to be a public health problem in many developing

countries (Crum NF 2003). Typhoid infection is generally transmitted by faeco-oral route and

may occasionally lead to an epidemic, particularly in areas with poor sanitation and limited

availability of clean, potable water (Ukwenya AY e,al 2011).

Who (2018). Typhoid fever is usually spread through contaminated food or water.

Once Salmonella Typhi bacteria are eaten or drunk, they multiply and spread into the

bloodstream. Urbanization and climate change have the potential to increase the global

burden of typhoid. In addition, increasing resistance to antibiotic treatment is making it easier

for typhoid to spread through overcrowded populations in cities and inadequate and/or

flooded water and sanitation systems.

(Sumer A et.al 2010) Intestinal perforation is a common cause of peritonitis necessitating

emergency surgical intervention. Perforation of the bowel is a serious abdominal

complication of typhoid fever. Although intestinal haemorrhage is the most common

complication of typhoid fever, ileal perforation continues to be the most frequent cause of its

high morbidity and mortality.

(Osarumwense DO. et,al 2010) A study conducted in a centre located in a densely populated

Edo State revealed a low incidence but high morbidity and mortality following typhoid ileal

perforation, which is at variance with reports from other studies in centres located in similar

localities. The causative organism (Salmonella Typhi) is passed into the environment via the
feaces of sufferer and carrier. Despite the lower incidence, however, this study recorded the

highest pre/postoperative morbidity (100%) and mortality (75%) in comparison with others.

Despite global scientific development typhoid fever and its complications continue to be a

great health problem, especially in developing countries (Sharma AK et.al 2013) . It is a

global health problem that can have a devastating impact on the resources of poor countries

and it is estimated that more than 33 million cases of typhoid fever occur annually causing

more than 500,000 deaths (Perera N et.al 2007).

(Bhutta ZA. 2006) Ileal perforation is a very serious complication of typhoid fever and

remains a significant surgical problem in developing countries like Nigeria, where it is

associated with higher morbidity and mortality, due to lack of adequate clean drinking water,

poor sanitation and lack of access to health facilities in remote areas and delay in hospital

presentation.

Study conducted in north-eastern Nigeria proves that Typhoid ileal perforation was most

common among males; abdominal pain, swelling and fever were common findings; single

site perforation was the most common intra-operative findings and excision and simple

closure was the most common operative procedure. Therefore early presentation, adequate

resuscitation and lower number of ileal perforations are associated with better prognosis

(Aliyu I et.al 2018).

1.2. EPIDEMIOLOGY

According to (WHO) WHO estimates the global typhoid fever disease burden at 11-20

million cases annually, resulting in about 128 000–161 000 deaths per year. Typhoid risk is
higher in populations that lack access to safe water and adequate sanitation. Poor

communities and vulnerable groups including children are at highest risk.

According to (NLM 2020) Global incidence of typhoid fever is 21 million cases annually

with 1-4% mortality predominately in 5-15years. Children account for >50% of all cases of

ileac typhoid perforation with peak age of 5-9years. Has equal M:F ratio in children in

contrary to adult with higher male prevalence. Perforation rate is about 10% in children

which increase in age reaching a high of 30% by the age of 12years. Has higher incidence in

raining season.

1.3. AIM OF THE STUDY

- To gain an understanding of the prevalence, morbidity and mortality rate of Tpyoid

ileal perforation
- To enhance our knowledge about the disease
- To ascertain management and care of the patient using evidence-based practice.
- To educate individuals on the causes and prevention of the disease.

1.4 ETIOLOGY

- Gram negative organism salmonella typhi and

- Paratyphi causing typhoid fevers
 CHAPTER 2

2.1.Anatomy and physiology

NORMAL ANATOMY
2.2. Pathophysiology
2.3. Clinical Manifestation

Salmonella Typhi lives only in humans. Persons with typhoid fever carry the bacteria in their
bloodstream and intestinal tract. Symptoms include

1. History of prolong high fever 2-3wks prior to onset , fatigue, headache, nausea.
2. Some patients may have a rash.
3. Abdominal pain
4. + or – Hematochezia prior to onset of pain
5. Diarrhea or constipation
6. + or – Jaundice maybe a complaint
7. Severe cases may lead to serious complications or even death
 References

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doi: 10.1007/s11894-003-0064-0

Osarumwense David Osifo, Scott O Ogiemwonyi . (2010).  incidence, morbidity and

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Sumer A, Kemik O, Dulger AC, Olmez A, Hasirci I, Kisli E, et al. Outcome of surgical

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Aliyu I, Michael GC, Musa A, Fikin AG, Abubakar BM; Typhoid ileal perforation in a semi-
urban tertiary health institution in north-eastern Nigeria Pages 168-173 | Received 17 Mar
2018, Accepted 18 May 2018, Published online: 26 Jul 2018.

World J Surg. (2020). Morbidity and Mortality of Typhoid Intestinal Perforation

Among Children in Sub-Saharan Africa ;National Library of medicine; A Scoping
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(WHO) https://www.who.int/news-room/fact-sheets/detail/typhoid