Dry Gangrene in Children with Typhoid Intestinal Perforation: A Report of Two Cases.

Intestinal perforation is a life-threatening complication of typhoid fever commonly seen in developing countries, but extraintestinal complications are infrequently reported. We report herein two cases of gangrene seen in children managed for typhoid intestinal perforation, highlighting the challenges faced in their management.

Primary versus delayed primary closure of laparotomy wounds in children following typhoid ileal perforation in Ile-Ife, Nigeria.

BACKGROUND: The optimal management strategy for dirty abdominal wounds has yet to be determined, but studies indicate that delayed primary closure (DPC) may be a reliable method of reducing surgical site infection (SSI) rate in these wounds. In this study, of dirty laparotomy wounds following typhoid ileal perforation (TIP), the SSI rate, incidence of wound dehiscence, and length of hospital stay (LOS) are compared in wounds primarily closed to those closed in the delayed primary fashion. PATIENTS AND METHODS: The study was conducted over a 12-month period. Consecutive patients aged between 0 and 15 years with typhoid ileal perforation (TIP) were enrolled and prospectively randomized to test (DPC) group and control (PC) group. Data including age, sex, diagnosis, type of wound closure, SSI, wound dehiscence, time to wound healing, and LOS were obtained and analyzed using SPSS version 16. RESULTS: Fifteen patients were recruited into DPC group while 19 patients were allocated to the PC group. The SSI rate was 80% in the DPC group compared to 63.2% in the PC group (P = 0.451). 17.6% of patients in the DPC group and 8.8% in the PC group had wound dehiscence, respectively (P = 0.139). The difference in LOS although longer in the DPC group was not statistically significant (DPC 23.47 ± 9.2, PC 17.68 ± 18.9, P = 0.123). CONCLUSION: DPC did not reduce the incidence of SSI and wound dehiscence, nor shorten LOS compared to PC. Therefore, PC of dirty wounds appears safe for the pediatric population and should be advocated.

A descriptive study of commonly used postoperative approaches to pediatric stoma care in a developing country.

Construction of an enterostomy is a common procedure in pediatric surgery. However, caring for the child with a stoma is challenging for parents in developing countries. Modern devices such as colostomy bags and accessories are expensive and not readily available. The purpose of this study was to describe methods of effluent collection and peristomal skin protection used by the mothers of colostomy patients. A prospective, descriptive study was conducted between January and December 2011 during the first three postoperative outpatient clinic visits among mothers of children who had a colostomy constructed in the authors' hospital. The mothers of 44 children (27 males, 17 females, median age 3.3 months, range 2 days to 11 years) consented to participate. Demographic and clinical data were obtained from the records, and mothers were interviewed and asked to describe their preferred methods of colostomy effluent collection and peristomal skin protection. The stomas also were inspected at each clinic visit. Anorectal malformations were the most common indication for a colostomy (32, 72.73%), followed by Hirschsprung's disease (11, 25%). Forty-two (42) patients had a divided sigmoid colostomy (95.45%); two patients had a right loop transverse colostomy (4.55%). Nine mothers alternated between two different collection methods. The diaper collection method was described most frequently (22 out of 53; 41.51%), followed by wraparound waistbands (19; 35.85%) and improvised colostomy bags (12; 22.64%). Peristomal skin excoriations were commonly seen within the first 3 weeks postsurgery and had mostly disappeared by the week 6 postoperative visit. Petrolatum jelly was the most commonly used barrier ointment. These locally available, acceptable, and affordable collection methods may be useful for children in other developing countries.

Macrostomia: a report of three cases.

Transverse facial clefts (macrostomia) are rare disorders that result when the embryonic mandibular and maxillary processes of the first branchial arch fail to fuse properly to form the corners of the mouth. Macrostomia may be seen alone or in association with other anomalies. It may be unilateral, extending along a line from the commissure to the tragus. It is usually partial, but rarely complete. Transverse facial clefts are more common in males, and commoner on the left when unilateral. We report on 3 patients with macrostomia managed in our unit. There were 2 girls with a bilateral transverse facial cleft and a boy with a left unilateral transverse facial cleft. All had a 3 layered repair of their clefts with Z-plasty repair of the skin. The longest duration of follow-up was 2 weeks. Strict adherence to the principles of surgical reconstruction is advised in the repair of macrostomia to prevent a poor treatment outcome.