Complications of typhoid fever in digestive surgery: a descriptive study based on 295 cases in a sub Saharan environment

Abstract Background: Typhoid fever is endemic in sub-Saharan Africa. Inadequate management often leads to complications, which are mainly surgical. Surgical complications are fraught with heavy mortality. Objective: To describe the surgical and digestive complications of typhoid fever in the Surgical Department of Tenkodogo Regional Hospital in Central-Eastern Burkina Faso. Methods: This was a descriptive study performed in the digestive surgery department of Tenkodogo Regional Hospital. It covered the period from January 2014 to December 2018. The records of all patients who were admitted for a surgical complication of typhoid fever were included. Results: Two hundred and ninety-five patients were treated for a surgical complication of typhoid fever. There were 184 male patients (62.4%) and 111 female patients. Their average age was 15.7 years. The reported complications were peritonitis by ileal perforation with 212 cases (71.2%), acute cholecystitis with 45 cases (13.8%), primary biliary peritonitis with 23 cases (6.8%) and liver abscess with 15 cases (5.1%). Patients were operated on by laparotomy and laparoscopy under general anaesthesia. The ileal perforations were treated according to 3 surgical procedures: excision-suture of the perforation, resection-anastomosis at the same time and ileostomy with restoration of the digestive continuity after 3 weeks. In cases of acute cholecystitis or biliary peritonitis, a cholecystectomy was proposed. The liver abscesses were drained by laparotomy or by puncture. Antibiotic therapy was associated with surgical treatment. The average length of stay of patients was 9 days. Twenty-eight patients died, which represents 9.5% mortality. Conclusion: The surgical complications of typhoid fever are responsible for heavy mortality in digestive surgery.