Etiological Spectrum of Ileal Perforation in Patients Presenting to Surgical Emergency
DOI:
https://doi.org/10.70749/ijbr.v3i7.2943Keywords:
Digestive System Surgical Procedures, Ileal Diseases, Intestinal Perforation, Peritonitis, Surgical Emergencies.Abstract
Background: Ileal perforation is a serious surgical emergency where a full thickness defect develops in the ileal wall and intestinal contents leak into the peritoneal cavity. Knowledge about etiological spectrum of ileal perforation is important for early diagnosis and proper surgical management in emergency departments. Objective: To determine the etiological spectrum of ileal perforation in patients presenting to surgical emergency. Study Design: Cross sectional study. Duration and Place of Study: This study was conducted from 16 March 2025 to 16 June 2025 in Accident and Emergency Department of Khyber Teaching Hospital, Peshawar. Methodology: A total of 258 patients aged 18–70 years of both genders presenting with acute abdomen and requiring laparotomy for perforated viscus were included. Etiological causes were categorized as ischemia, inflammation, malignancy, traumatic, iatrogenic, foreign body associated and unknown cause. Data were analyzed using statistical package for social sciences version 25. Results: Mean age was 43.95 ± 15.79 years and mean body mass index was 27.84 ± 3.12 kilograms per square meter. Male patients were 166 (64.3%) and females were 92 (35.7%). Rural residents were 152 (58.9%) and urban residents were 106 (41.1%). Inflammation was most common cause 64 (24.8%), followed by ischemia 52 (20.2%), trauma 36 (14%), malignancy 19 (7.4%), diverticula associated 13 (5%), iatrogenic 13 (5%), and foreign body associated 4 (1.6%). Conclusion: Inflammation and ischemia were the most common causes of ileal perforation, while many cases remained without clear etiology.
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1. Ashok, E., Ekka, N. M., Sinha, D. K., Gaurav, K., Kumar, B., Ahmad, N., Kumar, D., Chandra, S., & Choudhary, P. P. (2024). Clinical presentations, treatments, and complications of Ileal perforation at a tertiary center: A cross-sectional study. Cureus.
https://doi.org/10.7759/cureus.72027
2. Kumar, D., Garg, I., Sarwar, A. H., Kumar, L., Kumar, V., Ramrakhia, S., Naz, S., Jamil, A., Iqbal, Z. Q., & Kumar, B. (2021). Causes of acute peritonitis and its complication. Cureus.
https://doi.org/10.7759/cureus.15301
3. Dev, S., Pokhrel, K. M., Mulmi, U., Devkota, S., Dev, B., & Bhattarai, A. (2023). Chicken bone-induced ileal perforation peritonitis mimicking duodenal perforation peritonitis: A case report. Annals of Medicine & Surgery, 85(12), 6202-6205.
https://doi.org/10.1097/ms9.0000000000001404
4. Bourakkadi Idrissi, M., & Dkhissi, Y. (2024). Pneumoperitoneum and Chilaiditi syndrome: Navigating a diagnostic conundrum. Journal of Surgical Case Reports, 2024(2).
https://doi.org/10.1093/jscr/rjae056
5. Sharma, A., Sharma, R., Sharma, S., & Jhanwar, A. (2012). Ileal perforation in a patient with acquired immune deficiency syndrome. Indian Journal of Sexually Transmitted Diseases and AIDS, 33(2), 116.
https://doi.org/10.4103/0253-7184.102123
6. Audu, C. O., Schechtman, D. W., & Davis, F. M. (2023). Mesenteric ischemia. Clinics in Colon and Rectal Surgery, 37(06), 417-423.
https://doi.org/10.1055/s-0043-1777667
7. Kushram, B., Kori, A., Thakur, D. K., Kumar, A., & Singh, M. (2025). Assessment of intestinal obstruction: Clinical presentation, pathological findings and management. Bioinformation, 21(04), 892-896.
https://doi.org/10.6026/973206300210892
8. Li, Q., & Wang, J. (2024). The effect of protein nutritional support on inflammatory bowel disease and its potential mechanisms. Nutrients, 16(14), 2302.
https://doi.org/10.3390/nu16142302
9. Eswaravaka, S., Suhrid, C., Rao, B., Prabhakar, S., & Pandya, J. (2024). Revisiting physiological and operative severity score for the enumeration of mortality and morbidity (POSSUM) and Portsmouth-POSSUM (P-POSSUM) scores: Are they valid in cases of Ileal perforation? Cureus.
https://doi.org/10.7759/cureus.65733
10. Hameed, T., Kumar, A., Sahni, S., Bhatia, R., & Vidhyarthy, A. K. (2020). Emerging spectrum of perforation peritonitis in developing world. Frontiers in Surgery, 7.
https://doi.org/10.3389/fsurg.2020.00050
11. Skelhorne-Gross, G., & Kenny, J. (2023). Blunt and penetrating injury to the bowel: A review. Clinics in Colon and Rectal Surgery, 37(06), 424-429.
https://doi.org/10.1055/s-0043-1777668
12. Lee, S. B. (2026). Iatrogenic colon perforation: Endoscopic management or surgery. Clinical Endoscopy, 59(1), 33-39.
https://doi.org/10.5946/ce.2025.182
13. Onken, F., Senne, M., Königsrainer, A., & Wichmann, D. (2022). Classification und treatment algorithm of small bowel perforations based on a ten-year retrospective analysis. Journal of Clinical Medicine, 11(19), 5748.
https://doi.org/10.3390/jcm11195748
14. Jameel, A., Anwar, I., & Laique, M. H. (2023). Etiological spectrum of surgical acute abdomen among patients attending emergency department. Pakistan Journal of Medical and Health Sciences, 17(5), 94-96.
https://doi.org/10.53350/pjmhs202317594
15. Singh, S., Satsangi, A., Yadavalli, S. D., Singh, B., & Patil, G. (2020). Nontraumatic small bowel perforation: A review of demographics, aetiological factors, clinical presentation, radiological findings along with hematological and histopathological evaluation. World J Surg Surgical Res. 2020; 3, 1244.
16. Jain, D. N. (2024). A study to evaluate clinico-etiological factors responsible for small bowel perforation. African Journal of Biomedical Research, 1508-1513.
https://doi.org/10.53555/ajbr.v27i3s.2338
17. Ullah, S., Khan, M., Mumtaz, N., & Naseer, A. (2009). Intestinal obstruction: a spectrum of causes. Journal of Postgraduate Medical Institute, 23(2).
https://www.jpmi.org.pk/index.php/jpmi/article/view/87
18. Noonavath, R, Verma, A, Ratan, S. K. (2026). A retrospective review of ileal perforation in children – 5 years audit from tertiary care centre. J Neonatal Surg, 15(1):53-58.
https://www.jneonatalsurg.com/index.php/jns/article/view/9935
19. Njarekkattuvalappil, S. K., Thomas, M., Kapil, A., Saigal, K., Ray, P., Anandan, S., Nagaraj, S., Shastri, J., Perumal, S. P., Jinka, D. R., Thankaraj, S., Ismavel, V., Zachariah, P., Singh, A., Gupta, M., Ebenezer, S. E., Thomas, M. S., Ghosh, D., Kataria, K., … John, J. (2021). Ileal perforation and enteric fever: Implications for burden of disease estimation. The Journal of Infectious Diseases, 224(Supplement_5), S522-S528.
https://doi.org/10.1093/infdis/jiab258
20. Bhanuprakash, K. R, Aruna, M. S, Shetty, K. K. (2018). Clinical study and management of small bowel perforation in a tertiary care teaching institute. International Surgery Journal, 5(3), 855.
https://doi.org/10.18203/2349-2902.isj20180481
21. Masud, M., Khan, A., Adil, M., Gondal, Z. I., Aquil, A., Jahangeer, M. H., & Baig, S. (2016). Etiological spectrum of perforation peritonitis. Pakistan Armed Forces Medical Journal, (5), 756.
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