Abstract: Objective: To study the predictive value of combined detection of bacterial endotoxins(BT), D-lactic acid(D-LC), and lactate dehydrogenase(LDH) for intestinal perforation in patients with acute intestinal obstruction. Methods: A total of 106 patients with acute intestinal obstruction admitted to Hebei Chest Hospital from August 2021 to August 2023 were selected for retrospective study, including 31 patients with intestinal perforation(intestinal perforation group) and 75 patients without intestinal perforation(non-intestinal perforation group).Clinical data and BT, D-LC, LDH at baseline, after 6 h, 12 h and 24 h were compared between the two groups, receiver operating characteristic(ROC) curve was used to analyze the predictive value of BT, D-LC and LDH for intestinal perforation. Results: The proportion of patients with severe intestinal duct injury in the intestinal perforation group(100%) was higher than that the in non-perforation group(12.00%)(P<0.05). After 6 h, BT, D-LC and LDH in both groups showed an increasing trend. After 12 h, BT, D-LC and LDH began to decrease in the non-intestinal perforation, while they still showed an increasing trend in the intestinal perforation group, and BT, D-LC and LDH showed a decreasing trend after 24 h(P<0.05). BT, D-LC and LDH in the intestinal perforation group were higher than those in the non-intestinal perforation group at baseline, after 6 h, 12 h and 24 h(P<0.05). ROC analysis showed that the AUC of BT, D-LC and LDH in predicting intestinal perforation showed an increasing trend at baseline, after 6 h and after 12 h, and the AUC of BT, D-LC and LDH in predicting intestinal perforation was the highest after 12 h. After 12 h, the AUC of intestinal perforation predicted by BT and D-LC combined with LDH was 0.935(95% CI:0.870-0.974), the cut-off value was 0.125, the sensitivity was 90.32%, and the specificity was 85.33%(P<0.05).Conclusion: BT, D-LC and LDH are correlated with intestinal perforation in patients with acute intestinal obstruction, and patients with intestinal perforation have higher peak value of various indicators, longer duration and lower delay. Combined detection of the three indicators may be a predictive scheme for intestinal perforation to provide decision support for clinical diagnosis and treatment.