Biopsies were taken for histopathological examination from the edge of the perforation, omentum and mesenteric lymph nodes which proved the diagnosis of tuberculosis. Similar observations are reported by Akgun Y [28] and Serf R [29]. 11 cases of malignancy were found in our study. The majority Selleckchem XL765 of malignancies (9 cases)

involved the large bowel, while 2 cases showed involvement of ileocaecal junction. All carcinomas were identified as adenocarcinomas on histopathology. Surgical treatment of secondary peritonitis is highly demanding. Some authors have adopted laparoscopy as preferred surgical approach for the management of secondary peritonitis [30]. Laparoscopy is an emerging facility and in emergency setup, it is still in its infancy, being performed in only a few medical institutions of Pakistan. Due to the non-availability of laparoscopy in our emergency setup during the study period, no patient was treated laparoscopically. In our study, postoperative complications included wound infection (28%), septicaemia (20%) and electrolyte imbalance (7%). However, postoperative complication in secondary peritonitis reported by Jhobta RS [10] are respiratory tract infections (28%), wound infection (25%), septicaemia (18%)

GDC-0068 mouse and dyselectrolaemia (17%). Kim et al. [31] in their study report mortality rate of 9.9%. This is related to the delayed presentation of the patient to a definitive care hospital. In our study mortality rate was 16.7%. The high mortality in our setup could be attributed to the fact that this hospital caters to patients from far flung rural areas of the province. Illiteracy, low socio-economic status, improper infrastructure including inadequate transport and delayed referral to tertiary care hospital by the general practitioners are some of the reasons for these patients coming late to our medical facility. Conclusion The presentation of

secondary peritonitis in Pakistan continues to be different from its western counterpart. The In majority of cases the presentation to the hospital was late with well established generalized peritonitis L-NAME HCl with purulent/fecal contamination and varying degree of septicemia. Good pre-operation assessment and early management will decrease the morbidity, mortality and complications of secondary peritonitis. References 1. Adesunkanmi ARK, Badmus TA, Fadiora FO, Agbakwuru EA: Generalized peritonitis secondary to typhoid ileal perforation: Assessment of severity using modified APACHE II score. Indian J Surg 2005, 67:29–33. 2. Dorairajan LN, Gupta S, Deo SV, Chumber S, Sharma L: Peritonitis in India-a decade’s experience. Trop Gastroenterol 1995,16(1):33–38.PubMed 3. Ordonez CA, Puyana JC: Management of peritonitis in the critically ill patient. Surg Clin North Am 2006,86(6):1323–1349.PubMedCrossRef 4. Gupta S, Kaushik R: Peritonitis–the Eastern experience. World J Emerg Surg 2006, 1:13.PubMedCrossRef 5.