Case Report Dry Gangrene in Children with Typhoid Intestinal Perforation: A Report of Two Cases Lofty-John C. Anyanwu , 1 Aminu M. Mohammad, 1 Lawal B. Abdullahi, 1 Mustapha U. Ibrahim, 2 Aliyu U. Farinyaro, 1 Mohammed S. Aliyu, 1 and Stephen K. Obaro 3,4,5 1 Paediatric Surgery Unit, Department of Surgery, Aminu Kano Teaching Hospital, Bayero University Kano, Nigeria 2 Orthopaedic Surgery Unit, Department of Surgery, Aminu Kano Teaching Hospital, Bayero University Kano, Nigeria 3 Department of Paediatrics, Aminu Kano Teaching Hospital, Kano., Nigeria 4 International Foundation Against Infectious Diseases in Nigeria (IFAIN), Nigeria 5 Division of Pediatrics Infectious Disease, University of Nebraska Medical Center, Omaha, USA Correspondence should be addressed to Lofty-John C. Anyanwu; loftyjohnc@yahoo.com Received 7 April 2018; Accepted 23 September 2018; Published 8 October 2018 Academic Editor: Gregorio Santori Copyright © 2018 Lofty-John C. Anyanwu et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Intestinal perforation is a life-threatening complication of typhoid fever commonly seen in developing countries, but extraintestinal complications are infrequently reported. We report herein two cases of gangrene seen in children managed for typhoid intestinal perforation, highlighting the challenges faced in their management. 1. Introduction Salmonella enterica serovar Typhi, the causative organism in typhoid fever, is a gram-negative facultative anaerobic bacte- ria which commonly causes intestinal and systemic patholo- gies in the host [1]. Injuries caused by this organism on the intestinal mucosa result in the systemic translocation of the organism and other intestinal microbiota and may result in intestinal perforation [2]. Being a systemic pathogen, a num- ber of complications have been described in infected patients, although cases of gangrene are rarely reported [3–9]. We include in this report two cases of gangrene seen in children managed for typhoid intestinal perforation in our unit. 2. Case Presentation 2.1. Case 1. A 9-year-old girl was presented to our hospital on referral from a peripheral hospital with a one-week history of darkish discoloration of both feet and her left hand and a six-day history of a purulent feculent discharge from an exploratory laparotomy wound. She had presented to the referring hospital eight days earlier, with a two-week history of high-grade fever and a one-week history of a generalized abdominal pain and diarrhea. She had an exploratory lapa- rotomy at the referring hospital. Intraoperative findings include a feculent intraperitoneal collection and a single per- foration on the antimesenteric border of the terminal ileum. An intraoperative diagnosis of perforated typhoid enteritis was made, and the perforation was closed in two layers. One unit of blood was transfused postoperatively. On the first day of postsurgery, the patient developed darkish discol- oration of the left hand and both feet which were associated with pain. She was not a known sickle cell disease patient and had no past histories suggestive of intermittent claudica- tion. On the second day of postoperation, a purulent dis- charge from the lower aspect of the laparotomy wound was noted, and there was darkening of the feet and duskiness of the distal one-third of both legs. Due to the progressive worsening of the patient’s condition, she was referred to our hospital on the seventh day of postoperation. At presentation to our unit, she was acutely ill looking, febrile with a temperature of 38.1 ° C, dehydrated, not pale, and anicteric. Her respiratory rate was 30/minute with reduced air entry and coarse crepitations in both lower lung fields. She had a pulse rate of 130/minute, which was regular and of moderate volume. Only first and second heart sounds Hindawi Case Reports in Surgery Volume 2018, Article ID 7097014, 4 pages https://doi.org/10.1155/2018/7097014