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Gastrointestinal perforation

Definition

Gastrointestinal perforation is a hole that develops through the entire wall of the stomach, small intestine, large bowel, 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, including appendicitis, diverticulitis, ulcer disease, gallstones or gallbladder infection, and less commonly, inflammatory bowel disease, including Crohn's disease and ulcerative colitis.

It may also be caused by abdominal surgery.

Symptoms

Perforation of the intestine leads to leakage of intestinal contents into the abdominal cavity. This causes inflammation 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 (not in the stomach or intestines), suggesting a perforation. CT scan of the abdomen often shows the location of the perforation. The white blood cell (WBC) count is often higher than normal.

Treatment

Treatment usually involves surgery to repair the hole (perforation). Occasionally, a small part of the intestine must be removed. A temporary colostomy or ileostomy 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 exam, blood tests, CT scan, and x-rays.

Support Groups

Expectations (prognosis)

Surgery is usually successful, but depends on the severity of the perforation and the length of time to treatment.

Complications

Complications include:

• Bleeding
• Infection (including a widespread infection called sepsis, which can lead to death)
• Intra-abdominal abscess

Calling your health care provider

Call your doctor if you have severe abdominal pain, fever, nausea, vomiting, blood in your stool, or changes in bowel habits.

Prevention

Prevention depends on the cause. Diseases that may lead to intestinal perforation should be treated appropriately.

References

Turnage RH, Richardson KA, Li BD, McDonald JC. Abdominal wall, umbilicus, peritoneum, mesenteries, omentum, and retroperitoneum. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 18th ed. St. Louis, Mo: WB Saunders; 2008:chap 43.