Gastrointestinal perforation
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Synonyms and keywords: Bowel perforation; intestinal perforation; colonic perforation; gut perforation
Overview
Gastrointestinal perforation is a complete penetration of the wall of the stomach, small intestine or large bowel, resulting in intestinal contents flowing into the abdominal cavity. Perforation of the intestines results in the potential for bacterial contamination of the abdominal cavity (a condition known as peritonitis). Perforation of the stomach can lead to a chemical peritonitis due to leaked gastric acid. Perforation anywhere along the gastrointestinal tract is a surgical emergency.
Historical Perspective
Classification
Pathophysiology
Causes
Underlying causes include gastric ulcer, appendicitis, gastrointestinal cancer, diverticulitis, trauma, and Ascariasis.
Drug causes
Differentiating Gastrointestinal perforation from Other Diseases
Epidemiology and Demographics
Risk Factors
Screening
Natural History, Complications, and Prognosis
Natural History
Complications
Prognosis
Diagnosis
Diagnostic Criteria
History and Symptoms
Gastrointestinal perforation results in severe abdominal pain intensified by movement, nausea and vomiting. Later symptoms include fever and or chills.
Laboratory Findings
White blood cells are often elevated.
Other Imaging Findings
X Ray
On X-rays, free gas may be visible in the abdominal cavity.
CT
The perforation can often be visualised using CT.
Other Diagnostic Studies
Treatment
Medical Therapy
Treatment depends on the underlying cause, but surgical intervention is nearly always required.
Contraindicated medications
Bowel perforation is considered an absolute contraindication to the use of the following medications: