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Gastrointestinal perforation

Definition

Gastrointestinal perforation is a hole that develops through the 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

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:

  • Severe abdominal pain
  • Chills
  • Fever
  • Nausea
  • Vomiting

Exams and Tests

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

A CT scan of the abdomen often shows where the hole is located. The white blood cell count is often higher than normal.

Treatment

Treatment most often involves surgery to repair the hole. 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, people can be treated antibiotics alone if the perforation has closed. This can be confirmed by a physical exam, blood tests, CT scan, and x-rays.

Outlook (Prognosis)

Surgery is successful most of the time. However, the outcome will depend on how severe the perforation is, and for how long it was present before treatment.

Possible Complications

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

When to Contact a Medical Professional

Call your health care provider if you have:

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

Prevention

People will often have a few days of pain before the intestinal perforation occurs. If you have pain in the abdomen, see your health care provider right away. Treatment is much simpler and safer when it is started 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.

Review Date:8/11/2014
Reviewed By:Jenifer K. Lehrer, MD, Department of Gastroenterology, Frankford-Torresdale Hospital, Aria Health System, Philadelphia, PA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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