In our study, the most common cause of secondary peritonitis due to gastrointestinal tract Vemurafenib perforation was typhoid which was found in 134(43%) cases; this was followed by peptic ulcer disease in 56(18%) cases. Duodenal perforation was more common (11.9%) compared to gastric perforation (6.1%). Chaterjee H too reported typhoid as the commonest cause of perforations in two separate studies [16, 17]. We performed primary closure of the perforation in patients with typhoid peritonitis who were clinically stable and had minimal soling of the abdominal cavity. We selectively performed primary closure with proximal ileostomy in all other patients who presented late and had faecal contamination

of peritoneal cavity, friable and gut and/or poor clinical condition, this is also supported by other studies [18–22]. Acid peptic disease was the second commonest cause of secondary peritonitis in our study being found in 56(18%) cases. GSK461364 research buy These perforations were found either

along the first part of the duodenum anteriorly (11.9%) or in the pylorus of the stomach (6.1%). These patients presented with the classical signs and symptoms of peritonitis, and required early surgery for a favourable outcome. We found that in such cases, closure of the perforation using a Graham’s omental patch was a simple and safe procedure with low mortality, as supported by Subramanyam SG [23]. Dandpat MC studied 340 cases of Gastrointestinal perforations and found that 22(6.4%) patients developed secondary peritonitis secondary to perforated appendix

[24]. However, in our series, secondary peritonitis Blebbistatin research buy due to appendicular perforations was the underlying cause in 47 (15%) of patients. Afridi SP had reported that the patients who developed secondary peritonitis due to perforated appendix present with the typical history of pain starting in the periumbilical region than shift to the right iliac fossa, or originated directly in Amylase the right iliac fossa and then spread to all over the abdomen [25]. We also observed that most of the patients with appendicular perforation presented in the similar manner. The patients with perforated appendix belonged to young age group. Primary intestinal tuberculosis is uncommon in the west [26] but is still common in developing countries like Pakistan [27]. In our study, the clinical picture of the patients presenting with tuberculous perforation included symptoms such as abdominal pain, fever with night sweats and weight loss. Eighteen (5%) patients had history of subacute intestinal obstruction. Radiologic images revealed evidence of tuberculosis in 11(3.5%) patients. 19 (6%) of patients presented with peritonitis during the course of anti tuberculosis treatment. The commonest sites of involvement were terminal ileum and ileocaecal region though, multiple sites were also commonly found.