Surgical management of complicated gastrointestinal salmonellosis in children.

From January 1984 to October 1991, 11 consecutive patients with complication of Salmonella infection received surgical intervention at our hospital. The age at operation ranged from 4 days to 8 years old, with a mean of 1 year and 8 months. Most of them (64%) were under the age of one year. Eight cases were male, 3 cases were female. The most common pathogen was Salmonella paratyphi Gr. B (73%); the most common presenting symptoms and signs were abdominal pain (82%), pyrexia (82%) and muscle guarding (82%). The indications for surgery included pneumoperitoneum (55%), peritonitis (36%) and intestinal obstruction (9%); 6 cases received one stage operation, 5 cases received staged operations (enterostomy). The most commonly involved organ was ileum (54%). Ceftriazone (rocephin) was the drug of choice for the first 2 weeks postoperatively. Total parenteral nutrition (TPN) was used for at least 2 weeks. The postoperative complications included adhesion ileus (9%), high output enterostomy (9%), reperforation (9%), and wound infection (18%); there was no surgical mortality. Prompt diagnosis, early resuscitation and operative management are mandatory to avoid mortality.