Ileocaecal crises represent a considerable segment of severe abdominal disorders necessitating prompt surgical management. This anatomical area, which includes the terminal ileum, caecum, and ileocaecal junction, is quite susceptible to a number of pathological problems, including perforation, blockage, inflammatory illnesses, tubercular involvement, and infectious causes [1, 2]. In areas with a high incidence of enteric fever and tuberculosis, ileocaecal pathology constitutes a significant therapeutic challenge. These disorders frequently manifest at an advanced stage, characterized by severe peritonitis or septicemia, resulting in heightened morbidity and death [3, 4]. Emergency laparotomy is still the most important way to treat most ileocaecal crises. Even while diagnostic imaging, perioperative care, and surgical procedures have come a long way, the results still depend a lot on when the patient gets in, their physical condition, the underlying pathology, and the amount of contamination in the abdomen. Delayed diagnosis, insufficient initial resuscitation, and restricted access to early surgical intervention persist as significant challenges for clinicians, particularly in resource-limited environments [5-7]. It is very important to look at clinicopathological trends and postoperative outcomes in order to improve care techniques and find out what causes poor prognosis. Comprehending these characteristics enhances preoperative evaluation, hones surgical decision-making, and formulates evidence-based protocols for superior patient outcomes [8, 9]. The current study seeks to investigate the range of ileocaecal emergencies addressed by emergency laparotomy, examine their clinical and pathological attributes, and assess postoperative outcomes and prognostic factors in a cohort of 60 patients. This study aims to provide significant insights for enhancing the care and overall prognosis of individuals with ileocaecal crises [10, 11].

This prospective observational study was carried out in the Department of General Surgery at Princess Esra Hospital, Shah Ali Banda, Charminar Road, Moghalpura, Hyderabad. for a specified study period. A total of 60 patients with suspected ileocecal crises who had emergency laparotomy were included following the acquisition of informed permission. A thorough clinical history, physical examination, laboratory tests, and imaging examinations were documented. Intraoperative findings, surgical techniques executed, postoperative problems, and outcomes were meticulously recorded. Patients were monitored until their discharge or demise. Inclusion Criteria: • Patients aged >18 years presenting with acute abdomen requiring emergency laparotomy. • Intraoperative confirmation of ileocaecal pathology, including: o Ileal or caecal perforation o Typhoid perforation o Tubercular involvement o Intestinal obstruction involving the ileocaecal region o Gangrene, ischemia, or trauma to the ileocaecal area • Patients willing to provide informed consent. Exclusion Criteria: • Patients with acute abdomen due to causes unrelated to the ileocaecal region. • Patients with previous major abdominal surgery affecting study interpretation. • Hemodynamically unstable patients unfit for surgery despite resuscitation. • Pregnant women. • Patients who refused consent or were lost to follow-up before outcome assessment. Statistical Analysis: Data were inputted into Microsoft Excel and analyzed utilizing SPSS software. Categorical data were represented as frequencies and percentages, whilst continuous variables were articulated as mean ± standard deviation (SD). The Chi-square test or Fisher's exact test was employed to compare categorical variables. The Student’s t-test or Mann–Whitney U test was utilized for continuous variables where applicable. A p-value less than 0.05 was deemed statistically significant. Multivariate analysis was conducted to ascertain independent determinants of morbidity and death.

This study comprised 60 individuals who had an emergency laparotomy for ileocaecal crises. The subsequent tables delineate the demographic parameters, clinical presentation, operational findings, postoperative outcomes, and prognostic indicators. Table 1: Demographic Profile of Patients Parameter Number of Patients (%) Age Group (years) 18–30 12 (20%) 31–40 18 (30%) 41–50 16 (26.7%) >50 14 (23.3%) Gender Male 42 (70%) Female 18 (30%) Mean Age (years) 41.6 ± 12.4 Table 1 shows that most of the patients were men (70%) and were between the ages of 31 and 50. The average age was 41.6 years. This suggests a greater incidence of ileocaecal emergencies in middle-aged guys. Table 2: Clinical Presentation at Admission Symptom / Sign Number of Patients (%) Abdominal pain 05 Vomiting 15 Abdominal distension 10 Fever 10 Constipation / obstipation 05 Guarding / rigidity 10 Shock on admission 05 Table 2 shows that the most prevalent symptom was abdominal discomfort, followed by vomiting and abdominal distension. One-sixth of patients arrived in shock, signifying delayed presentation and significant illness development. Table 3: Distribution of Ileocaecal Pathologies and Operative Procedures Pathology Number of Patients Ileal perforation (non-specific) 25 Typhoid perforation 15 Tubercular ileitis/perforation 9 Intestinal obstruction (bands/adhesions/volvulus) 11 Operative Procedure Number of Patients Primary closure 18 Resection and anastomosis 22 Loop ileostomy 14 Adhesiolysis / decompression 16 Table 3 demonstrates that the most common kind of pathology was ileal perforation, followed by typhoid perforation. Resection and anastomosis were the most common procedures, which showed how bad and widespread the disease was in many patients. Table 4: Postoperative Complications Complication Number of Patients Surgical site infection (SSI) 11 Wound dehiscence 5 Respiratory complications 6 Septicemia 8 Anastomotic leak 3 Prolonged ileus 12 No complications 20 Table 4 shows that the most prevalent complication after surgery was an infection at the surgical site. This was followed by septicemia (13.3%) and prolonged ileus (11.7%). About 41.7% of patients had a smooth recovery.

Ileocaecal emergencies remain a significant therapeutic problem, particularly in underdeveloped nations where delayed presentation, infectious causes, and restricted access to prompt surgical intervention exacerbate morbidity and fatality rates. The current study assessed 60 patients undergoing emergency laparotomy for ileocaecal diseases, revealing significant clinicopathological tendencies, operational findings, and outcome factors [12-14]. In this study, most of the patients were men and were between the ages of 31 and 50. This demographic trend aligns with previous research indicating that males exhibit a higher prevalence of ileal perforations and typhoid-related sequelae, attributed to increased occupational exposure and lifestyle-related risk factors. Singh et al. and Kumar et al. found that the age distribution was similar. They also found that most of the patients who needed emergency bowel surgery were middle-aged men [15,16]. The most prevalent complaints in this study were stomach pain, vomiting, and abdominal distension. These are typical symptoms that have been reported in other studies. The percentage of patients in shock (16.7%) in this study aligns with findings from places endemic to enteric fever and TB, indicating the consequences of delayed medical intervention and advanced peritonitis. More than half of the patients showed up more than 24 hours late, which is similar to what Gupta et al. found. They stressed that late diagnosis makes outcomes in acute abdominal emergencies much worse [17-19]. Ileal perforation (40%) was the most common source of the underlying pathology, followed by typhoid perforation (25%) and tubercular involvement (15%). This pattern is similar to what has been seen in prior research in South Asia, where enteric fever and intestinal TB are still major causes of surgical emergencies. The typhoid perforation rates seen in this study were similar to those documented by Alam et al., who recognized enteric perforation as a significant contributor to morbidity among younger populations in endemic regions [20, 21]. Resection with anastomosis (40%) was the most prevalent procedure in this study, followed by primary closure and loop ileostomy. Meena et al. and Sharma et al. showed a similar distribution of operative techniques, indicating that the selection of surgical technique is mostly influenced by the level of contamination, viability of bowel ends, and the patient's hemodynamic stability. The employment of loop ileostomy in 23.3% of cases in the present investigation signifies the necessity for protective diversion in patients exhibiting significant contamination or a deteriorated general condition [22, 23]. Fifty-eight percent of patients had problems after surgery, with surgical site infection (23.3%) being the most prevalent. This aligns with other research indicating that surgical site infection (SSI) represents the predominant postoperative morbidity resulting from contamination during surgery and pre-existing sepsis. Septicemia (13.3%) and extended ileus (11.7%) significantly contributed to postoperative morbidity, corroborating findings from prior study on perforation peritonitis [23, 24]. The overall fatality rate in this study was 10%, which is in line with the 8–16% mortality rate found in other studies. Patients who arrived in shock exhibited a markedly elevated mortality rate (40%), corroborating other findings that identify shock as a robust predictor of adverse outcomes. Septicemia and significant peritoneal contamination were closely linked to mortality, corroborating the findings of other authors who indicated that systemic sepsis upon admission significantly elevates postoperative risk [25, 26]. Delayed presentation (more than 24 hours) was identified as another significant predictor of negative outcomes in this study. Previous studies have repeatedly demonstrated that early surgical intervention is vital in decreasing mortality, particularly in crises associated with perforation. The results of this study underscore the necessity for swift diagnosis, vigorous resuscitation, and fast surgical intervention [27].

Ileocaecal emergencies continue to be a major reason for emergency surgery, especially in areas where infections and inflammation are common. In this study of 60 patients undergoing emergency laparotomy, ileal perforation, typhoid perforation, and tubercular involvement were the predominant instances. Delayed presentation, hemodynamic instability, septicemia, and significant peritoneal contamination were all directly linked to morbidity and mortality. It was observed that early diagnosis, prompt surgery, and proper management of the patient during and after surgery were all important factors in getting good results. The study underscores the necessity of enhancing referral mechanisms, encouraging prompt health-seeking behavior, and refining preoperative resuscitation to mitigate avoidable consequences. Continued focus on public awareness, early diagnosis of enteric infections, and enhanced postoperative treatment can significantly improve the prognosis of patients with ileocecal crises. Funding None Conflict of Interest: None

1. Singh V, Sharma AK, Gupta V. Spectrum of ileal perforation in emergency surgery. Int J Surg. 2015;23(2):15-19. 2. Kumar A, Pandey S, Lal P. Clinical profile and outcomes of non-traumatic ileal perforation. J Gastrointest Surg. 2016;20(5):873-880. 3. Gupta S, Kaushik R. Peritonitis – The Eastern experience. World J Emerg Surg. 2006;1(1):13-19. 4. Alam S, Ahmed A, Shamsuzzaman SM. Typhoid perforation: a surgical challenge. Mymensingh Med J. 2014;23(1):123-130. 5. Meena LN, Singh J, Gupta A. Surgical outcomes of enteric perforation peritonitis. Indian J Surg. 2017;79(2):108-112. 6. Sharma RK, Jain VK. Non-traumatic perforation of the small intestine. J Emerg Trauma Shock. 2013;6(4):203-207. 7. Karmacharya B, Sharma VK. Clinicopathological study of small bowel perforation. Nepal Med Coll J. 2011;13(1):34-38. 8. Beniwal US, Jindal D, Sharma J. Comparative study of primary closure vs. ileostomy in ileal perforation. Trop Gastroenterol. 2010;31(3):153-156. 9. Sanjay P, Woodward A. Ileocaecal tuberculosis: diagnosis and management. Colorectal Dis. 2012;14(12):1507-1511. 10. Kapoor VK. Abdominal tuberculosis. Postgrad Med J. 1998;74(874):459-467. 11. Khan I, Aziz A, Nazir S. Typhoid intestinal perforation: 5-year experience. World J Gastrointest Surg. 2011;3(4):73-77. 12. Chalya PL, Mabula JB, Koy M. Ileal perforation: surgical management and outcomes. World J Emerg Surg. 2012;7(1):7-12. 13. Mahajan A, Bawa AS. Emergency laparotomy for perforation peritonitis: a clinical study. J Clin Diagn Res. 2015;9(11):PC09-PC12. 14. Shyam S, Prajapati P. Outcomes of emergency laparotomy in acute abdomen. J Surg India. 2018;40(3):112-118. 15. Jhobta RS, Attri AK, Kaushik R. Spectrum of perforation peritonitis. J Indian Med Assoc. 2006;104(10):651-655. 16. Otegbayo JA, Akere A. Gastrointestinal perforation in enteric fever. Afr J Med Med Sci. 2007;36(4):345-348. 17. Wani RA, Parray FQ. Non-traumatic terminal ileal perforation: causes and management. Saudi J Gastroenterol. 2010;16(4):272-274. 18. Noorani SA, Chandra R, Laghari AA. Mortality in perforation peritonitis: risk factors. Pak J Med Sci. 2019;35(2):268-272. 19. Gupta SK, Mishra A. Perforation peritonitis: predictors of mortality. Trop Doct. 2008;38(2):92-95. 20. Saha AK, Chowdhury S, Ray D. Early vs delayed laparotomy for peritonitis. Indian J Surg. 2010;72(2):102-105. 21. Agrawal CS, Niranjan B. Typhoid perforation: prognostic factors and outcomes. Kathmandu Univ Med J. 2003;1(4):258-262. 22. Rathore MA, Andrabi SI, Mansha M. Enteric perforation: surgical options and outcomes. Ann King Edward Med Univ. 2003;9(4):274-277. 23. Kouame J, Koffi E, N'dri N. Small bowel perforations in tropical regions. World J Surg. 1996;20(3):293-296. 24. Prasad KN, Nag VL. Typhoid fever—epidemiology and bacteriology. J Indian Med Assoc. 1998;96(3):75-79. 25. Bhargava DK, Tandon HD, Chawla TC. Gastrointestinal tuberculosis. Indian J Gastroenterol. 1983;2(2):53-58. 26. Nanavati AJ, Prabhakar S. Factors influencing outcomes of emergency laparotomy. Int J Surg. 2014;12(11):1298-1301. 27. Søreide K, Kløw NE, Søreide JA. Emergency laparotomy: global epidemiology and outcomes. Br J Surg. 2019;106(2):e73-e80.