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Background: Some recent studies have reported a decrease in mortality from typhoid ileal perforation. The present report aims to determine the prevalence, morbidity, and mortality of this disease in patients mostly drawn from a rural area., Methods: This is a retrospective study of 50 patients treated between January 1999 and December 2007 at the University of Nigeria Teaching Hospital, Enugu, Nigeria. The variables studied included patient demographics, clinical features, intraoperative findings, complications, and mortality. Statistical analysis was done with SPSS version 13., Results: Of the 50 patients included in the study, 22 were males with the highest rate in patients aged 20 years and younger. Fever was the commonest symptom and at initial presentation, the mean pulse and respiratory rates were significantly higher in the patients who subsequently died than in those who survived (P < 0.05). All the perforations occurred in the ileum; 62 % of the patients had solitary perforations, 28 % had double perforations, and 10 % had three or more. Fifty-eight perforations were treated by simple closure in two layers, 4 patients had ileal resection and anastomosis, and 2 underwent right hemicolectomy. The mean interval between operation and death was 1.7 days. The overall mortality rate was 30 %, but among those with three or more perforations, mortality was 100 %., Conclusions: Typhoid ileal perforation still carries a high mortality especially in rural areas. Those with tachycardia and tachypnea at presentation and those with three or more perforations are at a higher risk of dying from the disease.

Background: Ileostomy is usually performed for patients of typhoid intestinal perforation with poor general condition, but it is associated with significant morbidity. We have used the T-tube in such patients as an alternative to ileostomy., Methods: This is a prospective evaluation of a cohort of children with proven typhoid intestinal perforation. Patients with multiple perforations and poor general condition were managed with a T-tube inserted into the bowel lumen after closing all distal perforations (group 3). They were compared with patients who had primary closure of perforation (group 1) or bowel resection (group 2) to determine the efficacy of the use of T-tube., Results: The total number of patients for groups 1, 2, and 3 was 51, 4, and 12 (n = 67). The mean number of perforations for the three groups was 1, 3.5 +/- 0.58, and 4.25 +/- 0.97. The operation time for the three groups was 37.29 +/- 3.24, 59.25 +/- 3.09, and 59.17 +/- 4.17 minutes, respectively. The T-tube was removed after 13.17 days. The mean duration of fistula at T-tube site to heal was 8.58 +/- 2.11 days. The overall follow-up period was 10.94 +/- 1.15 months and none of the patients with T-tube placement had features of intestinal obstruction., Conclusions: In children with multiple typhoid intestinal perforations and poor general condition, the use of T-tube may be an effective management option.

Background: Typhoid fever (TF) is a severe febrile illness caused by Salmonella typhi. One of the most lethal complications of TF is ileal perforation (TIP). Although the mortality of associated with TIP has decreased slightly over the past decade, it is still high., Methods and Results: The records of the 82 surgically treated patients with TIP were evaluated retrospectively. There were 64 men with the mean age of 36.3 years (range: 7-68 years). In surgical treatment, debridement with primary closure was performed in 32 patients (39.0%), and wedge resection with primary closure was performed in 9 (11. 0%), resection with primary anastomosis in 9 (11.0%), and resection with ileostomy in 32 (39.0%). The most common postoperative complication was wound infection, which occurred in 24 patients (29.3%). The overall morbidity was highest in the ileostomy group. The overall mortality was 11.0% (9 patients). Age, gender, number, and localization of the perforations (p > 0.05) were not found to affect mortality, but prolonged preoperative period (p < 0.001), extended peritoneal contamination (p < 0.01), and ileostomy procedure (p < 0.001) were found to influence the increase in mortality., Conclusions: Early and appropriate surgical intervention with effective preoperative and postoperative care may improve survival in TIP.

Background: There is evidence that intussusception is associated with bacterial infection. It was hypothesized that a component of the bacterial wall may induce the intussusception. This study was intended to determine whether lipopolysaccharide from Escherichia coli or Salmonella can initiate intussusception in mice., Methods: Lipopolysaccharide was injected intraperitoneally in mice, and the animals were examined for the presence of intussusception from 2 to 192 hours after injection. Gastrointestinal transit was assessed by measuring the passage of charcoal in the small intestine. Transit index was defined as the ratio between the distance traveled by charcoal and the total length of the small intestine., Results: Intussusceptions were found in as much as 25.9% of lipopolysaccharide-injected animals, whereas in control animals, the incidence was zero. The threshold for the lipopolysaccharide effect was at 4 mg/kg and incidence reached a plateau at 8 mg/kg to 16 mg/kg. The incidence of intussusception peaked 6 hours after injection of lipopolysaccharide and declined to zero after 15 hours. To test the possibility that lipopolysaccharide induces intussusception by altering motility, its effect on transit index was measured. A dose of 12 mg/kg lipopolysaccharide reduced the transit index from 56.2+/-1.4% to 37.7+/-2.1% (p < 0.05). No microscopic histologic changes were found in the bowels with intussusception., Conclusions: Intraperitoneal bacterial wall lipopolysaccharide causes intussusception in mice by disturbing gastrointestinal motility.

We have previously shown that attachment of the rabbit enteroadherent Escherichia coli, strain RDEC-1, to ileal brush borders in vitro is mediated by both mannose-resistant, AF/R1 pili and mannose-sensitive, type 1 pili. Because the role of type 1, somatic pili as adhesins that mediate bacterial enteroadherence in vivo remains controversial, we examined adherence of RDEC-1 expressing either type 1 pili or AF/R1 pili to rabbit ileum in ligated loops and after oral infection of rabbits. A rabbit fecal commensal E. coli, 640, which also expressed type 1 pili was used as a control. After oral infection of rabbits we evaluated: (a) diarrhea, (b) fecal shedding of organisms, (c) luminal colonization of jejunum and ileum, and (d) mucosal adherence of bacteria to jejunum, ileum, and colon. RDEC-1 expressing either type 1 or AF/R1 pili adhered to enterocytes both in ileal ligated loops and in the distal ileum, cecum, and proximal colon of infected rabbits. In contrast, enteroadherence of 640 was not observed. Diarrhea developed in rabbits challenged with either type 1 or AF/R1 piliated RDEC-1, but not in rabbits fed 640. Seven days after infection of rabbits with RDEC-1 bearing type 1 pili, luminal colonization of jejunum (4.22 +/- 0.55 CFU/g, X +/- SE) and ileum (6.34 +/- 0.55) was the same as after infection with AF/R1 piliated RDEC-1 (jejunum 4.47 +/- 0.20, ileum 5.81 +/- 0.70) and significantly greater than luminal colonization by type 1 piliated 640 (jejunum less than 2.22 +/- 0.14, ileum less than 2.06 +/- 0.15).(ABSTRACT TRUNCATED AT 250 WORDS)