Outcome of primary closure of abdominal wounds following typhoid perforation in children in Ile-Ife, Nigeria

• Published in: African journal of paediatric surgery Vol. 6; no. 1; pp. 31 - 34
• Main Authors: Usang, U E, Sowande, O A, Ademuyiwa, A O, Bakare, T I B, Adejuyigbe, O
• Format: Journal Article
• Language: English
• Published: India Medknow Publications and Media Pvt. Ltd 01.01.2009; Medknow Publications & Media Pvt. Ltd; Wolters Kluwer Medknow Publications
• Subjects: Abdomen; Abdomen - surgery; Adolescent; Antibiotics; Bacteria; Care and treatment; Child; Child, Preschool; Children; Complications and side effects; Diseases; E coli; Female; Health aspects; Humans; Infant; Infant, Newborn; Intestinal Perforation - complications; Intestinal Perforation - microbiology; Intestinal Perforation - surgery; Male; Methods; outcome of primary closure of abdominal wounds; Patient outcomes; Prevention; Retrospective Studies; Studies; Surgical Wound Infection - epidemiology; Surgical Wound Infection - microbiology; Surgical wound infections; Teaching hospitals; Treatment Outcome; Typhoid fever; Typhoid Fever - complications; typhoid perforation; Wound Healing; Wounds and injuries; Nigeria
• ISSN: 0189-6725; 0974-5998
• DOI: 10.4103/0189-6725.48573

Abdominal wounds following surgery for typhoid perforation are classified as dirty, with an infection rate of over 40%. To date, the optimal method for closure of these wounds remains controversial. Delayed primary closure which was conventionally recommended as standard practice, is now considered to be of no value in preventing surgical site infection (SSI). This study evaluates the outcome of primary closure of this class of wounds in children in Ile-Ife, Nigeria, and advocates a multidisciplinary wound management protocol. This is a retrospective study of children aged < 1-15 years who had had surgery for typhoid perforation in a teaching hospital in south western Nigeria, over a period of ten years. Thirty-two patients, 18 males and 14 females, in the ratio of 1.3:1 were managed for typhoid perforation during the ten year period. All 32 patients had primary closure of their abdominal wounds. There was primary wound healing in six (18.8%) patients, while 19 (59.4%) patients had surgical site infections. Wound dehiscence, intraabdominal abscess, and faecal fistulas were the other complications documented in the study. Abdominal wounds of typhoid perforation, though classified as being dirty, can be closed primarily with good healing outcomes. A multidisciplinary approach to wound management will reduce the incidence of wound sepsis and its associated morbidity and costs.