Background: Prolonged post-operative ileus is associated with increased risk of other complications, length of hospital stays and health care related costs. Chewing gum has been shown to reduce duration of ileus in many elective surgeries, but there is a paucity of randomised controlled trials (RCTs) on its effect on duration of ileus among patients undergoing emergency surgery, specifically patients with peritonitis. The aim of this study is to determine the effect of chewing gum on duration of postoperative ileus following laparotomy for gastroduodenal perforations.Methods: This will be a randomised controlled trial done in 3 hospitals. Fifty-two patients will be randomised to 2 groups. Group A will receive chewing gum in addition to routine care, whereas group B will receive routine care only. The duration of postoperative ileus in the two groups which is the primary outcome, will be compared using the independent samples t-test in SPSS version 22. The length of hospital stay, in-hospital morbidity and mortality will be the secondary outcomes. This trial has been approved by Kampala International University research and Ethics committee (Ref No. KIU-2021-60) and Uganda national council of science and technology (Ref No. HS1665ES). Retrospective registration with the research registry has also been done (UIN: researchregistry8565). Highlights• Prolonged post-operative ileus significantly contributes to adverse surgical outcomes• Chewing gum has been shown to reduce duration of ileus in many elective surgeries• There is paucity of RCTs on role of chewing gum following surgery for peritonitis

Introduction: Secondary peritonitis is the second leading cause of sepsis worldwide. Drug-resistance to peritoneal cavity bacterial infection remains a public health threat especially in resource limited settings of Africa including Uganda. This study was aimed at determining the antibacterial susceptibility patterns and factors associated with secondary peritonitis among patients with acute abdomen who underwent surgery at a Regional Referral Hospital in Uganda. Methods: This was a cross sectional study conducted at Hoima Regional Referral Hospital (HRRH) that enrolled 126 patients with acute abdomen. After laparotomy, clinical samples were aseptically collected from patients with secondary peritonitis for culture and sensitivity using standard Microbiological methods. Binary logistic regression was used to identify factors associated with secondary peritonitis among patients with acute abdomen. Results: Majority of the patients were males (61.9%) with a mean age of 37.9(SD +/- 21.8). Secondary peritonitis was found in 57(45.2%) of the patients. Gram-negative bacteria were the most commonly isolated organisms with Escherichia coli (35.8%) and Klebsiella spp (17.0%) predominating. Imipenem 88.8%(8/9), Amikacin 88.8%(8/9), Ciprofloxacin 44.4%(4/9) and Gentamicin 44.4%(4/9) demonstrated sensitivity to the different isolated organism at varying degrees. Being a male (AOR = 3.658; 95% CI = 1.570–8.519, p = 0.003) and presenting 3 days after onset of symptoms (AOR = 2.957; 95%CI = 1.232–7.099, p = 0.015) were independently associated with secondary peritonitis. Conclusion Imipenem, Amikacin, Ciprofloxacin and Gentamicin should be considered for empirical therapy in cases of secondary peritonitis. Patients, more especially males with abdominal pain should be encouraged to present early to the hospital in order to minimise progression to secondary peritonitis.