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Gastrointestinal perforation

Gastrointestinal perforation is a hole that develops through the whole wall of the esophagus, stomach, small intestine, large bowel, rectum, or gallbladder. This condition is a medical emergency.

Alternative Names

Intestinal perforation; Perforation of the intestines

Causes, incidence, and risk factors

Gastrointestinal perforation can be caused by a variety of illnesses. These include:

It may also be caused by abdominal surgery.

Symptoms

Perforation of the intestine causes the contents of the intestines to leak into the abdominal cavity. This causes a serious infection called peritonitis .

Symptoms may include:

  • Abdominal pain - severe
  • Chills
  • Fever
  • Nausea
  • Vomiting

Signs and tests

X-rays of the chest or abdomen may show air in the abdominal cavity, called free air. This is a sign of a tear (perforation).

A CT scan of the abdomen often shows the location of the perforation. The white blood cell count is often higher than normal.

Treatment

Treatment usually involves surgery to repair the hole (perforation). Sometimes, a small part of the intestine must be removed. A temporary colostomy or ileostomy (to drain the small or large intestine) may be needed.

In rare cases, antibiotics alone can be used to treat patients whose perforations have closed. This can be confirmed by a physical examination, blood tests, CT scan, and x-rays.

Expectations (prognosis)

Surgery is usually successful. However, the success of surgery depends on how severe the perforation is, and for how long it was present before treatment.

Complications

The most common serious complication of perforation, even with surgery, is infection. Infections can be either inside the abdomen (abdominal abscess), or throughout the whole body. Body-wide infection is called sepsis . It can be very serious and can lead to death.

Calling your health care provider

Call your health care provider if you have:

  • Blood in your stool
  • Changes in bowel habits
  • Fever
  • Nausea
  • Severe abdominal pain
  • Vomiting

Prevention

Often people will have a few days of pain before the intestinal perforation occurs. If you have pain in the abdomen, see your health care provider immediately. Treatment is much simpler and safer when it is given before the perforation occurs.

References

Turnage RH, Badgwell B. Abdominal wall, umbilicus, peritoneum, mesenteries, omentum, and retroperitoneum. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 19th ed. St. Louis, Mo: WB Saunders; 2012:chap 45.

Wyers SG, Matthews JB. Surgical peritonitis and other diseases of the peritoneum, mesentery, omentum, and diaphragm. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger & Fordtran's Gastrointestinal and Liver Disease. 9th ed. Philadelphia, Pa: Saunders Elsevier; 2010:chap 37.

Updated: 7/25/2012

Jacob L. Heller, MD, MHA, Emergency Medicine, Virginia Mason Medical Center, Seattle, Washington, Clinic; and Joshua Kunin, MD, Consulting Colorectal Surgeon, Zichron Yaakov, Israel. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M. Health Solutions, Ebix, Inc.


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