In Reply

Sir, We, thank the author(s) for their keen interest in the article and for making very useful observations. The comments made by them are complementary to our article and we agree with the remarks regarding electrolyte abnormalities, selective nasogastric decompression and factors to decrease ileus in the postoperative period. Though, we, agree with authors’ note for hemoglobin levels as per surviving sepsis guidelines, we want to reiterate that hemoglobin levels in perforation peritonitis patients should be maintained at a reasonable levels, since, anemia in postsurgery patients of perforation peritonitis may lead to inadequate oxygen delivery and ischemia at the anastomotic site, causing its dehiscence. Iancu et al.1 in their retrospective analysis of host related prognostic factors and their predictive value for anastomotic leakage after colorectal resections, found hemoglobin levels <11 g/dl to be a significant factor in the logistic regression model. Antifungal treatment should be considered in peritonitis patients, who are at risk of developing fungal infections. These risk factors are abdominal surgery, use of total parenteral nutrition, mechanical ventilation and renal replacement therapy; patients with bacterial infection and/or sepsis, and diabetes.2 A positive peritoneal fungal culture is a significant risk factor for adverse outcome in patients with perforation peritonitis especially, when combined with a high Mannheim peritonitis index.3 While writing the review we may have overlooked the striking similarity of some contents on intraoperative management’ with the review by Eissa et al.,4 We wish to clarify it was un-intentional and we regret the same.