Aetiology

There are multiple causes of gastrointestinal perforation, including

Diverticulitis (most common in higher-income countries)
Peptic ulcer disease
Gastrointestinal malignancy, mainly gastric or colorectal (Fig. 1)
Iatrogenic, such as during routine endoscopy
Trauma, either through penetrating or blunt mechanisms
Foreign body (e.g. battery or caustic soda)
Appendicitis or Meckel’s Diverticulitis
Mesenteric ischaemia
Obstructing lesions (e.g. cancer, bezoar, or faeces/sterocoral)
Results in bowel obstruction, with subsequent ischaemia and necrosis
Severe colitis, such as Crohn’s Disease
Includes toxic megacolon from Clostridum Difficile or Ulcerative Colitis)
Excessive vomiting (Boerhaave Syndrome), leading to oesophageal perforation.