These issues are often the results of poverty, long distance from the hospitals and ignorance. The potential limitation of this study is the fact that information about some patients obtained retrospectively was incomplete and this might have introduced some bias in our findings. Also, data obtained retrospectively and failure to detect HIV infection during window period may have underestimated the prevalence of HIV infection in our study. However, despite these limitations, the study has highlighted our experiences with typhoid intestinal
perforation selleck and their outcome of surgical management in our limited-resource environment and has provided local data that can guide health care providers in the treatment of patients. The challenges identified in the management of
these patients in our setting need to be addressed, in order to deliver selleck chemical optimal care for these patients and improve their treatment outcome. Conclusion Typhoid intestinal perforation is still endemic in our setting and carries high morbidity and mortality. Delayed presentation, inadequate antibiotic treatment prior to admission, shock on admission, HIV positivity, low CD4 count (< 200 cells/μl), high ASA classes (III-V), delayed operation, multiple perforations, severe peritoneal contamination and presence of postoperative complications were the main predictors of mortality in this study. Early and appropriate surgical ATR inhibitor intervention, effective perioperative resuscitation, postoperative intensive care procedures, safe anesthesia, and delivery of wide-spectrum antibiotics with low resistance are highly recommended in the management of typhoid intestinal perforation in this region. Emphasis should be on preventive measures such as safe drinking water and appropriate sewage disposal, and typhoid vaccination. Acknowledgements We would like to express our gratitude to all those who provided support in preparation of this manuscript. Special thanks go to the staff members of Medical records department cAMP of Bugando Medical Centre and our residents in
surgical department for their support and cooperation rendered to us during data collection. References 1. Crum NF: Current trends in typhoid fever. Current Gastroenterol Rep 2003,5(4):279–86.CrossRef 2. Ukwenya AY, Ahmed A, Garba ES: Progress in management of typhoid perforation. Ann Afr Med 2011, 10:259–65.PubMedCrossRef 3. Hosoglu S, Aldemir M, Akalin S, Geyik MF, Tacyildiz IH, Loeb M: Risk factors for enteric perforation in patients with typhoid Fever. Am J Epidemiol 2004, 160:46–50.PubMedCrossRef 4. Osifo OD, Ogiemwonyi SO: Typhoid ileal perforation in children in Benin City. Afr J Paediatr Surg 2010, 7:96–100.PubMedCrossRef 5. Perera N, Geary C, Wiselka M, Rajakumar K: and Andrew Swann, R: Mixed Salmonella infection: case report and review of the literature. J Travel Med 2007,14(2):134–5.PubMedCrossRef 6.