Gastrointestinal perforation occurs when the wall of the intestinal system (stomach, small intestine, large bowel) has developed a hole through its entire thickness. Perforation of the gut leads to leakage of intestinal contents into the abdominal cavity, and peritonitis . Perforation anywhere along the gastrointestinal tract is a surgical emergency.

Alternative Names

Intestinal perforation; Perforation of the intestines

Causes, incidence, and risk factors

Gastrointestinal perforation is caused by a variety if illnesses, including appendicitis, diverticulitis, ulcer disease, Crohn's disease, and less commonly, infections of the bowel, such as infectious colitis.

Signs and tests

X-rays of the abdomen reveal air in the abdominal cavity suggesting perforation. CT scan of the abdomen often reveals the location of the perforation. The WBC is often elevated.

Treatment

Treatment usually involves surgery. The patient undergoes general anesthesia, and an incision is made in the abdomen. The abdominal cavity is washed out, and the perforation in the intestine or stomach is repaired. Occasionally, a temporary colostomy or ileostomy may be required. In rare cases, antibiotic therapy alone can treat perforations. This is only the case in patients who have contained and sealed off the perforation, and are not systemically ill. This is evident from physical exam, laboratory tests, and X-rays.

Expectations (prognosis)

Depending on the disease process, intestinal perforation can usually be successfully repaired with surgery.

Complications

Complications include bleeding, infection, and formation of intra-abdominal abscesses.

Calling your health care provider

Call your physician for any severe abdominal pain, fevers, nausea, vomiting, or changes in bowel habits.

Prevention

Depending on the cause, perforation can be prevented by preventing the primary disease process that leads to intestinal perforation. For ulcer disease, this involves appropriate medications. For diverticulitis, this involves adherence to a high fiber diet. Consult your physician regarding treatment for diseases that can cause perforation.