Spontaneous free perforation of the small intestine in adults

Table 1 Traumatic causes of intestinal perforation

Traumatic causes
Blunt abdominal trauma (e.g., bicycle handlebar injury)
Motor vehicle accident (incl. pelvic fracture)
Ingested foreign bodies (e.g., fishbone, needles, safety pins, magnets)
Endoscopic studies (e.g., endoscopy, ERCP, especially with papillotomy)
Surgical treatment (e.g., laparotomy, especially cholecystectomy, abdominal liposuction)

ERCP: Endoscopic retrograde cholangiopancreatography.

Table 2 Causes of free perforation of the small bowel

Immune-mediated or inflammatory

Crohn’s disease (CD)

Celiac disease or gluten-sensitive enteropathy (GSE)

Collagenous sprue

Graft-vs-host disease (GVHD)

Infections

Viral: Cytomegalovirus (CMV)

Bacteria: Salmonella paratyphi, mycobacterium tuberculosis

Parasites: Ascaris lumbricoides

Protozoa: Entameba histolytica

Drugs and biological agents

NSAIDs: Indomethacin

Enteric-coated potassium chloride

Chemotherapy (?steroids)

Monoclonal antibodies: Bevicuzimab

Congenital

Meckel’s diverticulum

Jejunal or ileal duplications

Metabolic

Homocystinuria

Vascular

Wegener’s granulomatosis

Giant cell arteritis

Allergic granulomatous arteritis (i.e., Churg-Strauss syndrome)

Henoch-schonlein purpura

Buerger’s disease

Atherosclerotic vascular occlusion

Radiation-induced vascular injury

Neoplasm

Primary (adenocarcinoma, EATCL, angiosarcoma)

Secondary (melanoma, breast, mesothelioma, lung)

NSAIDs: Non-steroidal anti-inflammatory drugs.