Gastrointestinal perforation
A 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.
Causes
Perforation of an organ can be caused by a variety of factors. These include:
- Appendicitis
Appendicitis
Appendicitis is a condition in which your appendix gets inflamed. The appendix is a small pouch attached to the end of the large intestine.
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- Crohn disease
Crohn disease
Crohn disease is a disease where parts of the digestive tract become inflamed. It most often involves the lower end of the small intestine and the be...
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Diverticulitis
Diverticula are small, bulging sacs or pouches that form on the inner wall of the intestine. Diverticulitis occurs when these pouches become inflame...
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- Peptic ulcer disease
- Ulcerative colitis
Ulcerative colitis
Ulcerative colitis is a condition in which the lining of the large intestine (colon) and rectum become inflamed. It is a form of inflammatory bowel ...
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- Chemotherapy agents
- Increased pressure in the esophagus caused by forceful vomiting
- Ingestion of caustic substances
It may also be caused by surgery in the abdomen or procedures such as colonoscopy or upper endoscopy.
Symptoms
Perforation of the intestine or other organs causes the contents to leak into the abdomen. This causes a severe infection called peritonitis.
Peritonitis
Peritonitis is an inflammation (irritation) of the peritoneum. This is the thin tissue that lines the inner wall of the abdomen and covers most of t...
Read Article Now Book Mark ArticleSymptoms may include:
- Severe abdominal pain
- Chills
- Fever
- Nausea
- Vomiting
- Shock
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 perforation. If the esophagus is perforated free air can be seen in the mediastinum (around the heart) and in the chest.
A CT scan of the abdomen often shows where the hole is located. The white blood cell count is often higher than normal.
CT scan of the abdomen
An abdominal CT scan is an imaging method. This test uses x-rays to create cross-sectional pictures of the belly area. CT stands for computed tomog...
Read Article Now Book Mark ArticleWhite blood cell count
A WBC count is a blood test to measure the number of white blood cells (WBCs) in the blood. It is a part of a complete blood count (CBC). WBCs are a...
Read Article Now Book Mark ArticleA procedure may help find the area of the perforation, such as an upper endoscopy (EGD) or a colonoscopy.
Treatment
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.
Colostomy
Colostomy is a surgical procedure that brings one end of the large intestine out through an opening (stoma) made in the abdominal wall. Stools movin...
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An ileostomy is used to move waste out of the body. This surgery is done when the colon or rectum is not working properly. The word "ileostomy" come...
Read Article Now Book Mark Article - 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.
A perforation from a colonoscopy may sometimes be closed during the procedure without surgery.
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. The presence of other illnesses or septic shock can also affect how well a person will do after 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. Sepsis can be very serious and can lead to death.
Sepsis
Sepsis is an illness in which the body has a severe, inflammatory response to bacteria or other germs.
Read Article Now Book Mark ArticleWhen to Contact a Medical Professional
Contact your health care provider if you have:
- Blood in your stool
- Changes in bowel habits
- Fever
- Nausea
- Severe abdominal pain
- Vomiting
- Call 911 or the local emergency number right away if you or someone else have ingested a caustic substance.
Call the local poison control center emergency number at 1-800-222-1222 if a person has ingested a caustic substance. This hotline number will let you talk to experts in poisoning.
Poison control center
For a POISON EMERGENCY call:1-800-222-1222ANYWHERE IN THE UNITED STATESThis national hotline number will let you talk to experts in poisoning. This ...
Read Article Now Book Mark ArticleDO NOT wait until the person has symptoms before you call for help.
Prevention
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.
Reviewed By
Jenifer K. Lehrer, MD, Department of Gastroenterology, Aria - Jefferson Health Torresdale, Jefferson Digestive Diseases Network, Philadelphia, PA. Review provided by VeriMed Healthcare Network. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
Brackenridge S, Thompson A. Abdominal sepsis. In: Vincent J-L, Moore FA, Bellomo R, Marini JJ, eds. Textbook of Critical Care. 8th ed. Philadelphia, PA: Elsevier; 2024:chap 90.
Landmann A, Bonds M, Postier R. Acute abdomen. In: Townsend CM Jr, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 21st ed. Philadelphia, PA: Elsevier; 2022:chap 46.
Matthews JB, Turaga K. 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. 11th ed. Philadelphia, PA: Elsevier; 2021:chap 39.