Status: Funded - Open
Surgical management of typhoid intestinal perforations at Mbarara Regional Referral Hospital; a pilot, prospective cohort study
Johanna Riesel, MD
BACKGROUND: Typhoid Fever is a life-threatening illness endemic to many low-and middle-income countries (LMICs) due to poor sanitation and hygiene. If left untreated, it progresses to perforations of the intestines, commonly referred to “Typhoid Intestinal Perforations” (TIP). There are an estimated 12-20 million cases of Salmonella Typhi infections per year, and In one study from Western Uganda, nearly half of all Typhoid cases progressed to TIP and the majority of patients affected were 19 years or younger.
GAP: TIP are a common source of morbidity and mortality in pediatric populations in Low-and Middle-Income Countries (LMICs), yet no evidence-based approach to surgical management or improving surgical outcomes of this condition exists.
HYPOTHESIS: A Planned Second Look (PSL) procedure will improve post-operative mortality and morbidity for patients with TIP.
METHODS: This is a pilot, prospective cohort study in which patients are stratified by illness severity using the Mannheim Peritonitis Index (MPI). Patients in the first cohort will receive routine surgical care at Mbarara Regional Referral Hospital in Uganda. Patients in the second cohort with MPI scores>26 will be eligible for the PSL procedure. Our primary outcome will be mortality, and secondary outcomes will be morbidity.
IMPACT: This study would lend evidence for improved management of TIP, a disease referred to as a “scourge” of pediatric populations in low-income settings. If the PSL proves beneficial, this could have immediate impact in improving surgical outcomes of children with TIP in Mbarara, and within a few years, many other limited-resource settings. Further, it will allow identification of regions in southwestern Uganda that generate high incidence rates of TIP in children which can then be targeted for education and prevention initiatives.
Massachusetts General Hospital
United States, Uganda