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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
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.
Perforation of the intestine leads to leakage of intestinal contents into the abdominal cavity. This causes an inflammation called peritonitis.
Symptoms
Symptoms may include:
- Abdominal pain - severe
- Chills
- Fever
- Nausea
- Vomiting
Exams and Tests
X-rays of the 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 person's 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.
Outlook (Prognosis)
Surgery is usually successful, but depends on the severity of the perforation and the length of time to treatment.
Possible Complications
Complications include:
- Bleeding
- Infection (possible, sepsis)
- Intra-abdominal abscess
When to Contact a Medical Professional
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.
Reviewed By: Jacob L. Heller, MD, Emergency Medicine, Virginia Mason Medical Center, Seattle, Washington, Clinic. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
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