Ileal Perforation in Geriatric Patients: A Systematic Review of Etiology and Histopathological Findings
DOI:
https://doi.org/10.35790/ecl.v14i2.67458Keywords:
ileal perforation; geriatric patients; histopathology; peritonitis; small bowel perforation; etiologyAbstract
Abstract: Ileal perforation in elderly patients is a rare but life-threatening surgical emergency associated with high morbidity and mortality. Its heterogeneous etiologies and atypical clinical presentations in geriatric populations often result in delayed diagnosis and poor outcomes. Understanding the underlying etiologies and histopathological characteristics is essential to improve diagnostic accuracy and clinical management. This study aimed to systematically evaluate the etiologies and histopathological findings of ileal perforation in patients aged ≥60 years. This was a systematic literature search was conducted in CLIB (The Cochrane Library), Embase, MEDLINE, PubMed, Scopus, Web of Science and Google Scholar for studies published between 2006 and 2026. Eligibility criteria included case reports, case series, observational studies, or randomized controlled trials studies involving geriatric patients with ileal perforation and available histopathological data or macroscopic findings. Study selection, data extraction, and quality assessment were performed independently by two reviewers using the Joanna Briggs Institute (JBI) Critical Appraisal Checklist. A total of 10 studies were included, all of which were case reports. The results showed that the included studies demonstrated heterogeneous etiologies, including infections, NSAID-induced injury, diverticular disease, trauma, ischemia, foreign bodies, and neoplasms such as gastrointestinal stromal tumors. Despite etiological diversity, all studies consistently reported transmural inflammation and necrosis as the final common histopathological pathway. Specific findings reflected underlying mechanisms, such as granulomatous inflammation in infectious causes and vascular thrombosis in ischemic conditions. In conclusion, ileal perforation in geriatric patients is characterized by diverse etiologies but a convergent histopathological pathway of transmural tissue destruction. Delayed diagnosis due to atypical clinical presentation significantly contributes to poor outcomes, emphasizing the importance of early recognition, comprehensive evaluation, and timely surgical intervention.
Keywords: ileal perforation; geriatric patients; histopathology; peritonitis; small bowel perforation; etiology
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