We could not establish the reason for the high seroprevalence of HIV among these patients although it is possible that these patients have an increased risk of exposure to HIV infection. This

calls for a need to research on this observation. HIV infection was found to be associated with poor postoperative outcome. This observation calls for routine HIV screening in patients suspected to have typhoid intestinal perforation. Surgical intervention is considered to be the standard treatment of choice for patients with typhoid intestinal perforation [16, 46]. In keeping with other studies [4, 6, 12–15, 25–28, 33], all patients in the present study underwent surgical treatment. One of the many factors affecting the surgical outcome in patients with typhoid intestinal perforation is time interval between duration of illness and surgical intervention GANT61 in vivo (perforation-surgery interval) mTOR activity [46, 47]. Early surgery can minimize the complications while delayed surgery leads to severe peritonitis and septic shock. In the present study, the majority

of patients were operated more than 24 hours after the onset of illness. Similar observation was reported by other studies done in developing countries [47]. Delayed definitive surgery in the present study may be attributed to late presentation due to lack of accessibility to health care facilities, lack of awareness of the disease as a result some patients with typhoid perforation may decide to take medications in the pre-hospital period with hope that the symptoms will abate. It is also possible that some clinicians managing the patients initially may not have considered perforation as a possible diagnosis. In resource-poor countries, difficulties in diagnosis, patient transfer, and AZD5153 chemical structure inadequate antibiotic treatment often result in delayed presentation

to a hospital [3, 36]. (-)-p-Bromotetramisole Oxalate The presence of single intestinal perforations in majority (84.6%) of our patients is consistent with other reports [6, 15, 29, 30]. The median age of the patients with single perforations in the present study was significantly higher than that of those with multiple perforations which is line with other reporters [38, 47]. We could not establish the reason for this observation. The number of intestinal perforation in patients with typhoid intestinal perforation has been reported to have an influence on prognosis. In the present study, patients with multiple perforations had significantly high mortality rates compared to those with single perforations. Beniwal et al [46] found that the number of perforation had effect on surgical outcome.