Exploring threatened traditional knowledge; ethnomedicinal studies of rare endemic flora from Lesser Himalayan region of Pakistan

ABSTRACT Himalayas are one among the world biodiversity hotspots harboring many endemic medicinal plants. Despite augmentation in the documentation of ethnopharmacological knowledge of medicinal plant species, information regarding endemic species is still underway. Current paper highlights the traditional medicinal uses of rare endemic and unexplored group of plants having potential for novel chemical constituents with effective pharmacological activities. In total, 142 informants (91 male and 51 female) including seventeen traditional healers were interviewed using semi-structured questionnaire, personal observations and group discussions. Interviews were taken in field or otherwise photographs were shown for identification. Females were interviewed indirectly through male family members. For data analysis, quantitative analytical approach was adopted using ethnopharmacological indices as Relative frequency of citations and Fidelity Level. In total, 38 endemic plant species belonging to nineteen families were utilized by the local inhabitants. Highest number of endemics was belonging to Ranunculaceae (7), followed by Gentianaceae and Rosaceae (4 each) with respect to number of species. Highest number of endemics was used in fever, wound healing, throat infection and tonic (4 species each). Root was the most widely used part (36.17%) in cure of diseases and the leading mode administered was decoction (25.49%). Highest use reports and RFC values were recorded for Pimpinella stewartii (58 citations, 0.41 RFC), Caltha alba var. alba (52 citations, 0.37 RFC). Endemic plant species considerably contribute toward ethnomedicinal knowledge and despite rarity, the communities prefer their utilization. Conservation of endemics is necessary for future availability to the local communities.

Frequency of causes of mechanical bowel obstruction

Objective: To find out the frequency of different causes of mechanical bowel obstruction

Study Design: Observational / descriptive study

Place and Duration of Study: This study was carried out the Surgical B Unit of MTI, Lady Reading Hospital Peshawar from March 2015 to December 2015 Patients and Methods: All the patients presented with signs and symptoms of bowel obstruction were included in the study while those with non mechanical bowel obstruction like paralytic ileus and peritonitis were excluded from the study. Patient's demographic features and all the data were recorded

Results: Total 50 patients were included in the study. The age range of the patient was 15-80 years with mean age was 42,98 +/- 17.60 years. Thirty seven 74% patients were male and 13 [26%] were female constituting male to female ratio of 2.84:1. Out of 50 patients operated for mechanical bowel obstruction, commonest cause of bowel obstruction was post operative adhesions which accounted for 17 [34%] followed by sigmoid volulus in 10 [20%] cases and intestinal tuberculosis in 8 [16%] patients

Conclusion: Adhesions and sigmoid volvulus were the common causes of intestinal obstruction

Although patients presenting with sub acute intestinal obstruction can be treated conservatively initially, should they develop signs and symptoms of gut ischemia, when conservative treatment fails or in most cases of acute intestinal obstruction immediate surgical exploration is still required

Ileostomies and colostomies; common reasons and complications of construction: one year study

Background: An intestinal stoma is an opening of intestine on the anterior abdominal wall made surgically. The commonly performed procedures include colostomy and ileostomy. The purpose of the present study was to identify indications for commonly performed intestinal stomas and to study complications related to it

Objective: To identify indications for commonly performed intestinal stomas and to study complications related to it

Study Design: Observational study

Setting: Department of General Surgery, Unit- B, Lady reading Hospital, Peshawar

Period: 1[st] Jan 2013, to 31[st] Dec 2013

Subjects and Method: A total of 106 patients who underwent surgery and ended up in intestinal stomas, ileostomy or colostomy, were included in the study. Indications, immediate and late complications of stomas were recorded

Results: A break up of 106 patients of different intestinal stomas. Majority [61.32%] of patients were males. There were 49 ileostomies and 57 cases of colostomy making a total of 106 patients. Main indications of Ileostomy were enteric perforation [55.10%], and intestinal tuberculosis [20.40%]. Main indications of colostomy were penetrating injuries [50.88%], and intestinal obstruction. In a total of 106 stomas local complications appeared in 23 [21.69%]. Skin excoriation, ulceration, lap and wound infection were the most common respectively. Seventy eight stomas including 36 ileostomies and 42 colostomies were closed on an average of 3 months after primary operation. There were 7 cases of wound infection, 2 anastamotic leak-ages and one mortality [1.3%] in the stoma reversal group

Conclusion: Common indications for intestinal stomas were abdominal penetrating trauma, enteric perforation, intestinal obstruction and intestinal tuberculosis. Main complications included local skin problems, wound infection and retraction

Frequency and causes of conversion of laparoscopic cholecystectomy into open cholecystectomy

To determine the frequency and causes of conversion of laparoscopic cholecystectomy into open cholecystectomy. Cross-sectional [descriptive] study. This study was carried out at Surgical Unit of Postgraduate Medical Institute, Lady Reading Hospital, Peshawar for 14 months, from 1-11-2010 to 31-12-2011. A total of 126 patients of symptomatic gallstones disease fulfilling the inclusion criteria were subjected to laparoscopic cholecystectomy and were followed through out the procedure to see for any conversion and its cause. The mean age of patients was 40.65 +/- 10.35 with range of 20-65 years. The total no of cases converted to open cholecystectomy were 11 out of 126. Thus frequency of conversion was 11 equal to 8.7%, with commonest cause being adhesions 9 out of 11 converted cases followed by hemorrhage 2 out of 11 conversions. Moreover conversion was more in male patients. 20.8% as compared to 5.9% in females. Laparoscopic cholecystectomy is the gold standard treatment modality in the management of symptomatic gallstones disease. Its one disadvantage is the conversion into open procedure. But conversion should not be considered as complication of the procedure rather it is mature decision by the surgeons to avoid unnecessary lengthening the duration of surgery once they encounter any difficulty or interoperative complication

Frequency of diaphragmatic trauma in fire-arm injury of abdominal cases and outcome of its management

To determine frequency of diaphragmatic trauma in fire-arm injuries of abdomen and to determine outcome of its management. Retrospective study. This study was conducted at Department of Surgery, Unit B, Lady Reading Hospital Peshawar over a period of one year from January 2014 to January 2015. Record of all fire-arm injury cases, who presented during study period, was analyzed. Data were collected on pre-designed proforma from admitted patient record [patients charts] and operation theatre notes register. Demographic data, site and frequency of injury to diaphragm, operative findings, and outcome were the variables of study. Out of total 83 patients of fire-arm injuries, 14 [16.8%] patients had diaphragmatic trauma. Mean age of patient was 27.14 years. Male to female ratio was 4.9:1. Left dome of diaphragm was injured in 9 [64.28%] and right dome was involved in 4 [28.57%] of cases and in one patient [7.14%] patients central tendon of diaphragm was injured together with injury to pericardium that got expired. Diaphragmatic injury though not as common in abdominal fire-arm injury. There should be however very low threshold for suspicion in cases of fire-arm injury of abdomen, where bullet trajectory or mechanism of injury is suggestive, because missing such injury is not devoid of complications. The patient should be thoroughly examined and investigated for exclusion of diaphragmatic injury

Post laproscopic cholecystectomy drain placement: a controversial issue

Objectives: To assess the benefits and harms of routine abdominal drainage after Laparoscopic Cholecystectomy

Study design: A prospective observational study

Place and duration: Department of surgery at Khyber Teaching Hospital, Peshawar from 1[st] Feb. 2009 to 30[th] April 2012

Methodology: The data of 300 patients who underwent laparoscopic cholecystectomy was analyzed. The patients were divided in two groups each of 150 patients. Group -A, included patients without drain and Group -B, included patients with drain. Operative and Post operative results of both groups were compared with regard to signs, symptoms, early and late complications and hospital stay using univariate analysis

Results: Among total of 300 patients the male; female ratio was 1:3.The post op nausea [32%, n=48] and vomiting [18.6%, n=28] was less in patients without drain [group A]. Whereas abdominal pain [22.6%, n=34] and shoulder tip pain [15.3% n=23] was less in patients with drainage tube [group B]. Port site wound infection [11.3%, n=17] was more in group B. The hospital stay was less in the non drain group

Conclusion: Prophylactic drainage after a borderline case of laparoscopic cholecystectomy has found to be of no benefit rather it increases hospital stay and renders the patient prone to infections but it still remains a matter of individual preference

Surgical site infection; frequency after open cholecystectomy using Southampton wound scoring system in surgical unit Khyber teaching hospital Peshawar

To assess the post operative wound complication after open cholecystectomy for uncomplicated Cholelithiasis. Cross sectional descriptive. Surgical unit of Khyber Teaching Hospital Peshawar Pakistan. 223 patients underwent elective open cholecystectomy January 2011 to July 2012. 90% patients had normal healing [grade 0 or I] ,7.5% had minor complications [grade II or III], 2.5% patients had major complication [grade IV or V] recorded during hospital stay. On follow-up in out-patient department 81%patients found to have normal healing [grade 0 or I], 15% patients had minor complications [grade II or III] and 4% patients had major complications [grade IV or V]. There was an increase noted in wound grades during follow up for surgical site infections as compared to their record during hospital stay. Southampton wound scoring system is a useful tool for detection of surgical site infection and standardization. Auditing of surgical site infection by Southampton wound scoring will help the patient, surgical team and sterilization protocol to be improved

First degree hemorrhoids; efficacy of injection sclerotherapy experience in surgical department

Traditionally the treatment of Ist, 2nd and 3rd degree haemorrhoids is conservative management with fibre rich diet and better defecation discipline. If symptoms prevail then there are a wide range of treatment modalities. To evaluate the efficacy of injection Sclerotherapy for First degree haemorrhoids using 5% Phenol in Almond oil. This case series study was conducted on 83 patients with first degree piles in Surgical-C unit, Department of Surgery, Khyber Teaching Hospital Peshawar from 01/09/2010 till 01/03/2011. After Informed consent, injection Sclerotherapy with 1-2ml of 5% Phenol in Almond oil was injected in the sub mucosal plane of each pile case above the dentate line. Patients were reviewed at 3 weeks interval for bleeding per rectum for effectiveness of the procedure. A total of 83 patients with first degree haemorrhoids included in the study out of which 62 [74.7%] were male and 21 [25.03%] were female with M: F=2.99:1. Average age 41.1 years+0.1 SD with range 20-60 years. Efficacy was observed in 68 [81.83%] patients where 15 [18.07%] patients showed no results. Injection sclerotherapy is simple, convenient and effective outdoor procedure for first degree haemorrhoids

Diagnostic laparoscopy in the management of post appendectomy pain right iliac fossa

Objective: To determine the cause for pain right iliac fossa [RIF] after Appendectomy by Diagnostic laparoscopy in patients with normal investigations

Study Design: A Prospective Observational study

Place and Duration: Surgical A ward, Khyber Teaching Hospital Peshawar, from April 2009 to May 2011

Methodology: All those patient who continued to have pain in the RIF, more than 6 weeks after appendectomy,or more than 3 opd visits and normal investigations of genitourinary system and abdominopelvic ultrasound were included. Patients with symptoms of genitourinary system and pelvic inflammatory disease [PID] were excluded

Results: Fifty three patients were included in the study. Age range was from 15-42 years with 23 [43. 39%] patients aged less than 20 years, 15 [28.30%] 21-30 years,11 [20.75%] 31-40 years and 4 [7.54%] were above 40 years. Males were 19 [35.84%] and 34 [64.15%] were females, In 41 [77.35%] cases appendectomy had been done in emergency as they presented as acute appendicitis and 12 [22.64 %] were elective cases. Appendectomy was performed by open method in 45 cases [84.90%] and laparoscopically in 8 [15.09%] patients Diagnostic Laparoscopy was done in all patients and the findings included, adhesions in 21 cases [39.62%] tuberculosis in 9 cases [16.98%], PID in 7 cases [13.20%], ovarian cyst in 5 cases [9.43%] and a long appendicular stump in 2 [3.77%] and 1 [1.88%] terminal ileitis, while no cause was found in 8 [15.09%] patients

Conclusions: Post appendectomy pain RIF can be due to postoperative adhesions, pelvic inflammatory disease, ovarian cysts and abdominal tuberculosis. Diagnostic laparoscopy should be done to find out the cause in patients with inconclusive investigations

Comparison of conventional pyodine dressing with honey dressing for the treatment of diabetes ulcers

To compare the conventional pyodine dressing with honey dressing in terms of recovery time and outcome [healed or ended up with amputation] in diabetic foot ulcers. This quasi-experimental study was performed in surgical "C" ward, Lady Reading Hospital Peshawar from November 2007 to November 2008. All Wegner's grade I-IV, unilateral diabetic foot ulcer patients were admitted and their blood sugar profile, cardiac and renal status were investigated. Patients were assigned to group A and B with simple convenience method. After ample wound debridement group A and B were treated with daily conventional Pyodine dressing and Honey dressing respectively and their recovery time, outcome were recorded during the 10 weeks follow up period. A total of 100 patients with 50 patients in each group A and B were enrolled in the study with mean age 56 +/- 8.0 years and male to female ratio of 1.7:1. Recovery time was significantly quicker in the Group B [Honey Dressing] as compared with the group A [conventional Pyodine dressing] with a p-valve of <0.0001. Healing rate was 69% and amputation rate was 31% as a whole. Healing rate was 66% in the Group A in comparison with 72% in the group B while amputation rates were 34% and 28% in the group A and B respectively with no statistical significance with a p-value of 0.6658. Honey dressing is more effective than conventional Pyodine dressing in terms of recovery time in the treatment of diabetic foot ulcer

Surgical treatment of vesicovaginal fistula; an audit of 69 cases

The aim of this study is to assess the outcome of patients undergoing repair of vesicovaginal fistula. This descriptive study which was conducted from May 2002 to March 2008 the Department of Urology Lady Reading Hospital Peshawar. A total of 69 patients with Vesicovaginal fistula were included in this study. A detailed history and physical examination with special emphasis on previous gynecological and obstetrical events was recorded. All these patients underwent routine investigations like HB%, CBC, Urianalysis, renal function test and viral profile with ultrasonography of the abdomen and pelvis. Intravenous Urography [IVU] was offered to those patients who had upper tract dilatation on ultrasonography. Preliminary cystoscopy and Vaginoscopy was performed in all patients to diagnose VVF and plan the surgical approach. The mean age was 39.07 [+10.031] years. Thirt eight [55%] patients developed fistula due to obstetrical reasons while 30 [43-47%] had gynaecological surgeries and only one patient developed fistula after radiotherapy. The average size of the fistula was 3.36 cm: Trans abdominal repair of fistula was done in 58 [84.1%] patients while 11 [15.9%] has transvaginal repair. Successful repair was achieved in 65 [93.7%] patients. Vesicovaginal fistula can be successfully managed surgically. Proper preoperative assessment of the patients is mandatory for selection of the surgical approach

Outcome of open versus laproscopic appendicectomy in department of surgery, lady reading hospital, Peshawar

To compare safety and benefits of laparoscopic versus open appendicectomy in a randomized control clinical trial. Between January 2008 and October 2009 one hundred and twenty patients [86 male and 34 female] with suspected acute appendicitis were assigned either to laparoscopic [n=60] or open [n=60] appendicectomy. Surgical technique was standardized for both laparoscopic and open procedure. The patients were analyzed in terms of the following aspects and findings; operation time, postoperative pain, intra and post operative complications, hospital stay and return to normal daily activities. There was no mortality. Wound infection [8.3%] and intra-abdominal abscess [11.6%] formation rate was significantly higher in open group than in the laparoscopic group [1.6%] and [3.3%] respectively. Postoperative pain scores [assessed by a pain distress variable, indicated on visual linear scale 0 to 10 and a pain activity scale, indicated on visual linear scale 0 to 10] was significantly lower in laparoscopic group. Hospital stay was significantly shorter in laparoscopic group [p<0.0353] and mean operation time was similar in both groups. One patient [1.6%] was converted from laparoscopic to open appendicectomy due to diffuse pelvic adhesions. Though operation time was same but complications, pain and hospital stay was less in the Laparoscopic group

Laparoscopic cholecystectomy: an audit of cases done at a tertiary care hospital

The study aims to describe the complications and hospital stay associated with laparoscopic cholecystectomy. During the period from 01 August 2007 to 31 July 2009, all patients who were operated with laparoscopic cholecystectomy were included. The age, gender and other related data including the outcome and complications in 245 laparoscopic cholecystectomy cases were recorded. The findings documented in numbers and percentages were compared and discussed with those of other studies. 194[78.79%] were females and 51[21.21%] were males. Ages of female patients ranged from 25-51 years and of males from 28-54 years. Most of the patients were discharged on the 1[st] post-operative day. There were 13 cases converted to open surgery [5.3%]. Laparoscopic cholecystectomy was successfully completed in the remaining 232 patients with an average operating time of 93.74 +/- 21.7. Twenty four patients experienced morbidity. These included infections [n=10], bleeding [n=4], biliary peritonitis [n=5], visceral injury [n=1], pneumonia [n=2] and partial small bowel tear [n=2]. No bile duct injury or mortality was seen. Laparoscopic cholecystectomy is being performed in this setting with acceptable morbidity, mortality and conversion rates. A concerted effort to increase the performance of laparoscopic cholecystectomy may increase cost effectiveness in this setting

Per-operative findings and post-operative complications with laparoscopic appendicectomy

To study the per-operative findings and post-operative complications that arise with laparoscopic appendicectomy. Material and Methods: This descriptive study was conducted in Surgical "A" and Surgical "C" Unit of PGMI, Lady Reading Hospital from April 2006 to December 2008. Patients with acute appendicitis, short history, age ranges from 15 to 50 years and recurrent appendicitis were included in this study, while patients with appendicular mass, appendicular abscess, pregnancy and with previous abdominal surgery were excluded. All the data was collected by using a proforma. Data was analyzed by descriptive statistics. Out of 60 patients admitted for Laparoscopic Appendicectomy [LA], 36[60%] were males and 24[40%] were females. Only 6[10%] patients required conversion from laparoscopic to open surgery. Problems and per-operative complications were encountered in 9[15%] patients. These were dense adhesions due to inflammation 4[6.66%], localized perforation 2[3.33%], diffuse peritonitis 2[3.33%] and bleeding during procedure 1[1.66%]. Postoperative complications were seen in 5[8.33%] cases, out of which 2[3.33%] patients developed port site infection, 1[1.66%] patient developed postoperative ileus, 1[1.66%] patient developed partial bowel obstruction and 1[1.66%] patient presented with right iliac fossa abscess. There was no mortality. All patients resumed normal activity within 6-7 days of operation and were well satisfied up to median follow-up of 5-6 months. Majority of the patients were males. Per-operative findings were adhesions, perforation and peritonitis. Post-operative complications were port-site infection, ileus and bowel obstruction. Majority recovered within a week time

Percutaneous nephrostomy for the relief of upper urinary tract obstruction: an experience with 200 cases

To assess the role of Percutaneous Nephrostomy in upper obstructive uropathy. This was a descriptive study, conducted at Department of Urology, Lady Reading Hospital and Institute of Kidney Diseases, Hayatabad Medical Complex Peshawar from January 2006 to December 2008 on 200 patients of upper obstructive uropathy undergoing Percutaneous Nephrostomy. Fluoroscopy and Ultrasonography were used as guiding tools for accurate puncture of the renal tract. The patients were kept in the ward and their renal function tests were checked daily. All the data was collected on a structured proforma and analysis was done on SPSSv 10. A total of 200 Percutaneous Nephrostomy were attempted in 200 patients. The mean age of the sample was 41.6 +/- 12.68 years. Male to female ratio was 2.3:1. The causes included Stone disease in 104 [52%], Pyonephrosis in 52 [26%], Malignancy in 20 [10%], Renal tract tuberculosis in 12 [6%], Obstetrical trauma in 8 [4%] and Ureteric Injury due to Fire Arm in 4 [2%] patients. It was successful in 192 patients, while there was a failure in 8 cases [4%]. Considerable relief in terms of symptoms and renal biochemistry was observed with in a week. The mean blood urea level of 265 mg/dl before PCN dropped to 37 mg/dl and mean serum creatinine of 10.5 mg/dl dropped to 1.2 mg/dl respectively in all patients except 12 who were declared to have End Stage Renal Disease [ESRD]. Percutaneous Nephrostomy improves the patient's condition both in terms of urinary output and renal parameters

Anatomical position of appendix in emergency care patients

To identify the anatomical position of the appendix in patients presenting at the emergency surgical ward, Lady Reading Hospital Peshawar. This descriptive study was conducted in surgical 'A' Unit, Lady Reading Hospital, Peshawar from January to June 2008. Patients coming to emergency surgical ward were examined after detailed history and investigation; and then operated. Position of appendix along with other findings was noted. 100 patients were admitted and examined. 68% were male and 32% were female. During surgery retrocaecal position was the most common [78%] followed by pelvic position in 16% of patients. Perforated appendix was observed in 06% [all retrocaecal appendixes]. Retrocaecal appendix was the commonest in patients presenting to emergency with acute appendicitis. Less symptoms/signs lead to delay in diagnosis and complications

Experience with the surgical management of fracture penis

To know the etiology, complications and outcome of surgical management of fracture penis. This descriptive study carried out in the surgical departments of Lady Reading Hospital Peshawar from April 2000 to March 2005. Patients with the clinical diagnosis of fracture penis were admitted and operated. All patients except those with haematuria were catheterized. Most of these patients were explored via a circumcoronal incision and the defect in the tunica of corpus cavernosum repaired with 3/0-vicryl suture. No drain was used and a light compression dressing was done in all patients. Catheter was removed on the second postoperative day. Follow up was arranged at 6 and 24 months of operation. During the study period 51 patients were operated for fracture penis. Mean age at presentation was 32 years. The commonest cause of fracture penis was manual fiddling with the organ to overcome an erection [39.2%]. The incidence of associated urethral injury was 1.96% [n=1/51]. The commonest mode of presentation was with a cracking sound, local pain and immediate detumescence [90%, 98% and 94% respectively]. Average hospital stay was 3.4 days. Immediate postoperative complication was urinary retention in 2 patients [3.92%]. Long-term complications were negligible. There was only one readmission at 6 months for urethral stricture that responded well to optical urethrotomy. The commonest cause of fracture penis is manual manipulation to overcome an erection. The best treatment option is immediate surgical repair

Fogarty balloon catheter ablation of posterior urethral valves in neonates

Neonates with posterior urethral valves in developing countries, where costly endoscopic instruments are usually not available, are a special problem. The objective of this study was to evaluate the efficacy of fogarty balloon catheter ablation of posterior urethral valves as an alternative to endoscopic valve fulgaration. From January 2006 to December 2006, we received 07 neonates with Posterior Urethral Valves which were subjected to this technique. Their age range was between 5-26 days, while the weight range varied between 2.5 Kg to 3.5 Kg. Valves were ablated by using size 6F Fogarty catheter in the main operation theater under general anesthesia. Technique was successful in all the 7 neonates which was evident by a good stream of urine. Two patients had Grade III, while two patients had Grade IV vesicoureterric reflux before ablation. In patients with Grade IV reflux, reflux downgraded to Grade III on MCUG done 3 months after ablation. Patients with Grade III reflux were lost to follow up. Ablation of posterior urethral valves with Fogarty balloon catheter in neonates is simple, economical and effective way to treat these patients. Endoscopic valve fulgaration in neonates is hazardous and this technique is a good alternative, especially in developing countries

Transurethral resection versus transurethral incision of the prostate: a subjective and objective analysis

To assess and compare the outcome and complications of transurethral prostatectomy [TURP] versus transurethral incision of the prostate [TUIP] in patients having bladder outlet obstruction. Fifty patients suffering form benign prostatic hyperplasia [BPH] with prostate size of <30 gms were included in this study. Group a [25 patients] underwent TURP while in group B [25 patients] TUIP was performed. The patients were assessed using International Prostatic Symptoms Scoring System [IPSS], uroflownetry, TRUS and postvoid residual urine volume. Follow up was done at 1,3,6 and 9 months intervals. There was no statistically significant difference in the mean age among the two groups. IPSS score dropped by 81.55% for group A and 85.71% for group B at 9 months postoperatively from baseline. The overall improvement in maximum flow rates as recorded for both groups was 172.60% and 249% respectively while it was 182.8% and 279% for group A and B in average flow rates. The mean drop in postvoid residual urine volume for group A was -88.50% and -99.02% for group B. Overall 84% of patients in group A and 92% of patients in group B were well satisfied with the outcome of procedures. TUIP is an effective and comparable treatment modality for BPH with gland size of < 30 grams. Results of TURP and TUIP were comparable, but TUIP was simple and easier to perform, with less morbidity and shorter operation time than TURP

Pseudomyxoma peritonei: a review of 17 cases

To evaluate the various presentations, causes and management of Pseudomyxoma Peritonei [PMP], and to create awareness among young surgeons regarding its importance. Retrospective study from Jan. 1999 to Dec. 2005. Surgical Unit of Khyber Teaching Hospital, Peshawar and Gynaecology and Obstetrics Unit, Hayatabad Medical Complex, Peshawar. All patients who had Pseudomyxoma Peritonei during the study period. The clinical records of all patients undergoing laparotomy for various causes were reviewed and cases of PMP separated. Their biodata, clinical presentation, clinical diagnosis, investigation results, operative findings, histopathology report and outcome were recorded. Out of 23,573 cases that underwent laparotomy 17 cases of PMP were on record. All were diagnosed incidentally per-operatively. Most [47.05%] cases were seen in the age group of 30-40 years and 58.82% patients were females. Abdominal pain, mass, abdominal distension and intestinal obstruction were the common presenting features. Ultrasound and CT scan reported three cases as ovarian cysts, three as multiple encysted fluid collections with thin cyst walls, two as ascites, two as ascites with peritoneal thickening, but none as PMP. Surgery was the mainstay of treatment. Appendicectomy with clearing of mucin in 11[64.70%], oophorechtomy and appendicectomy in 3[17.64%], bilateral oophorechtomy and hysterectomy in 2[11.76%], right hemi-colectomy in 1[5.88%] and second look surgery for complications were done in 2[11.76%] cases. Mortality was 11.76% and due to complication including one due to intestinal obstruction and another due to septicemia following second look surgery. Histopathological tissue diagnosis was available in only 13 cases and included mucinous adenoma appendix in five, mucinous cystadenoma ovary in three, mucinous epithelial cells of unknown origin in four and mucinous cystadenoma of borderline malignancy in one case. PMP is under reported in our setup. Pre-operative diagnosis is difficult and incidental findings usually go unnoticed due to lack of awareness and standard management protocol. There is a need to create awareness among surgeons, radiologists, pathologist and oncologist regarding this condition for the better outcome