An audit of secondary peritonitis at a tertiary care university hospital of Sindh, Pakistan

A retrospective analysis of 311 patients of secondary peritonitis was done from July 2008 to June 2010 at Liaquat University Hospital Jamshoro, Hyderabad, Sindh, Pakistan. All cases found to have peritonitis as a result of perforation of any part of gastrointestinal tract at the time of surgery were included in the study. All cases with either primary peritonitis or that due to anastomotic dehiscence were excluded.A total of 311 patients were studied. Most of the patients were males (77%) and (89%) were in the third and fourth decades of life. Majority of the patients presented with pain (97%) associated with bowel symptoms. Most common site of perforation was small bowel (ileal 59%, jujenal 2%). In this series, most common risk factor of perforation was typhoid (43%). Ileostomy was the most commonly performed procedure. Overall morbidity was 48.5% and mortality was 17%.Considering the relatively higher rate of typhoid perforation quoted in this study, it is vital that typhoid fever ought to be eliminated by improved sanitation and immunizing programmes, otherwise surgeons will be confronted with its complications.Generalized peritonitis is a common surgical emergency in developing countries [1]. Despite advances in surgical techniques, good antimicrobial therapy and intensive care support, it carries high morbidity and mortality while its management remains difficult and complex [2]. Peritonitis can be classified as primary, secondary or tertiary, depending upon the source of microbial contamination. Primary peritonitis is secondary to extra-peritoneal sources, the infection spreading mainly through haematogenous dissemination without visceral perforation. Secondary peritonitis, on the other hand, is caused by resident flora of the gastrointestinal or urogenital tracts, the organisms reaching peritoneum secondary to a mechanical break. Non-responding secondary peritonitis either due to failure of the host inflammatory response or overwhelming super infection leads