Gastrointestinal perforation (patient information)

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mohammed Abdelwahed M.D [2]

Gastrointestinal perforation patient information

Perforation is a hole that develops through the wall of a body organ.
This problem may occur in the esophagus, stomach, small intestine, large intestine, rectum, or gallbladder.

Perforation of an organ can be caused by a variety of factors. These include:
Appendicitis
Cancer
Crohn’s disease
Diverticulitis
Gallbladder disease
Peptic ulcer disease
Ulcerative colitis
Bowel obstruction
Chemotherapy agents
It may also be caused by surgery in the abdomen or procedures such as colonoscopy

Perforation of the intestine or other organs causes the contents to leak into the abdomen. This causes a severe infection called peritonitis.

Symptoms may include:

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 most often involves emergency surgery to repair the hole.
Sometimes, a small part of the intestine must be removed. One end of the intestine may be brought out through an opening (stoma) made in the abdominal wall. This is called a colostomy or ileostomy.
A drain from the abdomen or other organ may also be needed.
In rare cases, people can be treated with antibiotics alone if the perforation has closed. This can be confirmed by a physical exam, blood tests, CT scan, and x-rays.

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.
The presence of other illnesses can also affect how well a person will do after treatment.

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.
Sepsis can be very serious and can lead to death.

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

Chen DC, Barie PS, Hiatt JR. Peritonitis and intraabdominal infection. In: Vincent JL, Abraham E, Moore FA, Kochanek PM, Fink MP, eds. Textbook of Critical Care. 6th ed. Philadelphia, PA: Elsevier Saunders; 2011:chap 105.

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. Philadelphia, PA: Elsevier 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 and Fordtran’s Gastrointestinal and Liver Disease. 10th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 38.