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A review of 60 patients undergoing surgery of typhoid perforation at the Ahmadu Bello University Teaching Hospital in Northern Nigeria between January 1981 and April 1987 was performed. Solitary perforation of the terminal ileum was found in 45 of 58 (78%) patients. 52 (87%) patients had debridement of the edge of perforation and simple closure. The overall hospital mortality was 57%. Important prognostic factors identified were blood urea level and duration of perforation before admission. In order to improve prognosis in typhoid perforation, patients must present early to hospital where early diagnosis, aggressive resuscitation and prompt surgery should be carried out.

In a prospective study of typhoid fever in Ahmadu Bello University Hospital, Zaria, the relative diagnostic sensitivities of blood culture and bone marrow culture were studied. The results in 64 patients with proved diagnosis of typhoid fever (either by recovery of S. typhi from stool, blood and/or bone marrow or by a positive Widal agglutination test) are presented. Forty-four per cent and 59% of the patients yielded S. typhi on blood and bone marrow cultures, respectively. In 31 patients who were investigated by both blood and bone marrow cultures, the yields of S. typhi were 35% and 61% respectively. This difference is statistically significant (P less than 0.05). In this study bone marrow culture proved to be the most sensitive diagnostic test for typhoid fever. A simple technique of bone marrow aspiration is described and its use is recommended for large general teaching hospitals.