{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T13:37:32Z","timestamp":1793367452309,"version":"4.5.0"},"reference-count":31,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"4","license":[{"start":{"date-parts":[[2026,4,9]],"date-time":"2026-04-09T00:00:00Z","timestamp":1775692800000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":["J West Afr Coll Surg"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Typhoid fever is a severe infectious disease prevalent in developing countries. This enteric fever can cause ulceration with perforation, typically in the terminal ileum. There is insufficient evidence regarding the prevalence and morbidity of perforated typhoid in endemic areas such as Togo, West Africa. Our aim was to evaluate and improve mortality rates in patients with typhoid perforation at Hospital of Hope (HOH).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and Methods:<\/jats:title>\n                    <jats:p>A retrospective review of 180 patients with perforated typhoid at HOH in Togo, West Africa, examined surgical outcomes from January 1, 2020, to January 7, 2024. We assessed the effectiveness of a new institutional treatment protocol implemented in February 2023. The change was driven by a higher-than-expected mortality rate. Additionally, demographic, treatment, clinical, and surgical characteristics were abstracted.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      From January 2020 to July 2024, the mortality rate was 20.00% (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      = 36); 69.44% of patients who died suffered from septic shock (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      = 25). To mitigate septic shock, HOH\u2019s protocol change lowered the threshold for damage control surgery including performing an ileostomy. This change was associated with 44% lower odds of death (15.45% vs. 25.14%,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.056). The mortality rate of patients undergoing surgery with only one perforation (13.51%,\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      = 15\/111) was lower compared to those with moderate (6.52%\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      = 3\/46) or severe contamination (40.74%,\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      = 22\/54) and\/or multiple perforations (26.58%,\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      = 21\/79). Of surviving patients (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      = 55) with an ostomy, 85.45% (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      = 47) underwent stoma reversal.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion:<\/jats:title>\n                    <jats:p>This demonstrates that ileostomies can be a safe and effective management therapy of typhoid perforations in settings of late presentation, malnutrition, and low resources.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.4103\/jwas.jwas_8_25","type":"journal-article","created":{"date-parts":[[2026,4,9]],"date-time":"2026-04-09T16:00:17Z","timestamp":1775750417000},"page":"418-424","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Typhoid Fever Surgical Outcomes in West Africa Improved with Ileostomies: A Single-Hospital Study"],"prefix":"10.4103","volume":"16","author":[{"given":"Dena","family":"Ferguson","sequence":"first","affiliation":[{"name":"Department of Surgery, Hospital of Hope, Mango, Togo"},{"name":"Department of Surgery, Creighton University, Omaha, NE, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bryce","family":"Nattier","sequence":"additional","affiliation":[{"name":"Department of Surgery, Hospital of Hope, Mango, Togo"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charles","family":"Filipi","sequence":"additional","affiliation":[{"name":"Department of Surgery, Creighton University, Omaha, NE, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Danielle B.","family":"Dilsaver","sequence":"additional","affiliation":[{"name":"Department of Surgery, Creighton University, Omaha, NE, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2026,4,9]]},"reference":[{"key":"CIT0002-20261030","first-page":"1042","article-title":"Prognostic factors in typhoid heal perforation: A prospective study of 53 cases","volume":"99","author":"Edino","year":"2007","journal-title":"J Natl Med Assoc"},{"key":"CIT0003-20261030","first-page":"58","article-title":"Typhoid ileal perforation: Analysis of morbidity and mortality in 89 children","volume":"11","author":"Ekenze","year":"2008","journal-title":"Niger J Clin Pract"},{"key":"CIT0004-20261030","doi-asserted-by":"crossref","first-page":"9","DOI":"10.4103\/0189-6725.59351","article-title":"Operative management of typhoid ileal perforation in children","volume":"7","author":"Nuhu","year":"2010","journal-title":"Afr J Paediatr Surg"},{"key":"CIT0005-20261030","doi-asserted-by":"crossref","first-page":"259","DOI":"10.4103\/1596-3519.87040","article-title":"Progress in management of typhoid perforation","volume":"10","author":"Ukwenya","year":"2011","journal-title":"Ann Afr Med"},{"key":"CIT0006-20261030","first-page":"22","article-title":"A review of typhoid perforation in a rural African hospital","volume":"22","author":"Agbakwuru","year":"2003","journal-title":"West Afr J Med"},{"key":"CIT0007-20261030","doi-asserted-by":"crossref","first-page":"96","DOI":"10.4103\/0189-6725.62857","article-title":"Typhoid ileal perforation in children in Benin city","volume":"7","author":"Osifo","year":"2010","journal-title":"Afr J Paediatr Surg"},{"key":"CIT0008-20261030","doi-asserted-by":"crossref","first-page":"e000810","DOI":"10.1136\/bmjgh-2018-000810","article-title":"Perioperative mortality rates in low-income and middle-income countries: A systematic review and meta-analysis","volume":"3","author":"Ng-Kamstra","year":"2018","journal-title":"BMJ Glob Health"},{"key":"CIT0009-20261030","doi-asserted-by":"crossref","first-page":"122","DOI":"10.5958\/0976-5506.2017.00095.X","article-title":"Profile of typhoid fever in children from a tertiary care hospital in Bhubaneswar, Odisha","volume":"8","author":"Swain","year":"2017","journal-title":"Indian J Public Health Res Develop"},{"key":"CIT0010-20261030","doi-asserted-by":"crossref","first-page":"1121","DOI":"10.1007\/s00383-014-3592-9","article-title":"Predictors of mortality in children with typhoid ileal perforation in a Nigerian tertiary hospital","volume":"30","author":"Talabi","year":"2014","journal-title":"Pediatr Surg Int"},{"key":"CIT0011-20261030","doi-asserted-by":"crossref","first-page":"e93784","DOI":"10.1371\/journal.pone.0093784","article-title":"Case fatality rate and length of hospital stay among patients with typhoid intestinal perforation in developing Countries: A systematic literature review. 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