Gastrointestinal perforation

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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:

Surgery

Prevention

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References

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