Background: Intra-abdominal hypertension is a common underestimated clinical condition that can lead to morbidity and mortality. One of the potential complications is ileal mucosa damage and the increase of TNF alpha expression, while early decompression treatment has shown potential benefit to reduce ileal damage. Objectives: To determine the difference in ileal mucosa histopathological damage and TNF alpha expression in intra-abdominal hypertension between non-decompression and decompression conditions.Methods: This study employed experimental design using a post-test only control group. Thirty Wistar albino rats were divided equally into 3 groups according to treatment: a healthy control group (K), an intra-abdominal hypertension group without decompression (P1), and an intra-abdominal hypertension group with decompression treatment (P2). Intra-abdominal hypertension was induced by mechanical obstruction of the anal canal. After intra-abdominal hypertension was induced and treatment was completed, ileal mucosa erosion or ulceration, villous shortening, and TNF alpha expression were observed as parameters of ileal mucosa damage.Results: Ileal mucosa damage and TNF alpha expression are the most frequently observed in the intra-abdominal hypertension group (P1), followed by the decompression treatment group (P2), then the healthy control group (K). Post hoc pairwise comparisons using Fisher's exact tests with Bonferroni correction (α = 0.0167) shows that the decompression treatment group (P2) has lower levels of mucosa erosion or ulceration (p = 0.37) and villous shortening (p = 0.628) compared to the intra-abdominal hypertension group (P1), but neither is statistically significant. Similarly, ordinal logistic regression shows that the decompression treatment group (P2) has no difference in levels of TNF alpha expression compared to the intra-abdominal hypertension group (P1) [OR = 1.38, 95% CI: 0.25–7.65, p = 0.716].Conclusion: There is no difference in ileal mucosa histopathological damage and TNF-alpha expression in intra-abdominal hypertension between non-decompression and decompression conditions.