Prevalence, Anatomic-pathologic Findings, and Associated Factors of Nontraumatic Ileal Perforations Among Patients with Gut Perforation: A Multicenter Cross-sectional Study

Abstract Background: Nontraumatic ileal perforation is a cause of obscure peritonitis characterized by severe toxicity and high mortality. This burden is disproportionately greater in LMICs due to poor hygiene practices, burden of HIV infection, and other comorbidities. This study aimed to determine the prevalence, anatomic-pathologic findings, and associated factors of nontraumatic ileal perforation at 3 selected hospitals in Uganda. Methodology: This was a cross-sectional study of 149 consecutive sample participants that used a structured checklist. We conducted bivariate and multivariate analyses using SPSS v21.0 (IBM), for which p<0.02 and 0.05, respectively, were considered to indicate statistical significance. Results: Nontraumatic ileal perforation was more prevalent among males (20.1%; 149) and peasants/farmers (41.6%; 149) of rural residence (22.1%; 149). The majority of the study participants had typhoid perforations (79.1%; 149). Most ileal perforations occurred 20-39 cm from the ileocecal junction (76.4%; 149), a perforation size/diameter of 0.5-1 cm was more common (58.1%; 149), and a single isolated perforation was more common (74.4%; 149). However, all perforations mainly occurred at the ante mesenteric border. Being an HIV-positive person was associated with greater odds of developing NTIP than was being a non-HIV-positive person. AOR 8.344, p = 0.015 (p<0.05). Additionally, patients treated with open and closed pit latrines were more likely to develop nontraumatic perforation than were those treated with water flash latrines. AOR 12.971, p = 0.004 (p < 0.05). Conclusion This study established that nontraumatic ileal perforation is more prevalent among male peasants living in rural areas and with typhoid fever. Being HIV positive or using a closed pit or open type of latrine was associated with high odds of nontraumatic ileal perforation.