Causes and treatment of gastrointestinal perforation

The gastrointestinal tract consists of the stomach, small intestine, and large bowel. It is possible for a perforation, or hole, to develop in the wall of the gastrointestinal tract. This condition is called gastrointestinal perforation.

Gastrointestinal perforation is a painful condition that can lead to further health complications, so emergency surgery is often necessary.

This article explores the causes and symptoms of gastrointestinal perforation. It also covers complications, diagnosis, treatment, and when to see a doctor.

What is gastrointestinal perforation?

Gastrointestinal perforation may lead to further complications.

Gastrointestinal perforation is a hole in the wall of the gastrointestinal tract. Other names for the condition include:

ruptured bowel

intestinal perforation

perforation of the intestines

Most people who have gastrointestinal perforation will have a hole in their stomach or small intestine.

A hole in the large bowel, also known as the lower intestine, occurs less frequently. Researchers estimate that perforations of the lower intestine only affect 4 in every 100,000 people in the European population.

A perforation can cause the contents of the stomach, small intestine, or large bowel to seep into the abdominal cavity. Bacteria will also be able to enter, potentially leading to a condition called peritonitis, which is life-threatening and requires immediate treatment.

Peritonitis is inflammation of the peritoneum, the thin layer of tissue that lines the abdomen. Without treatment, peritonitis can cause blood poisoning, or sepsis. Sepsis may lead to organ failure.

People with a gastrointestinal perforation, therefore, need emergency medical care. Intestinal perforations are the most common surgical emergency that occurs worldwide.

Causes

Many different conditions can cause gastrointestinal perforation, including:

volvulus — a bowel obstruction that happens when the large bowel becomes twisted

colon cancer

diverticulitis — an inflammatory condition that affects the large bowel

peptic ulcers in the stomach or small intestine

ischemic colitis — inflammation of the large bowel due to an inadequate supply of blood

gallstones

gallbladder infection

inflammatory bowel disease

reactions to nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen

injury or trauma to the abdomen, such as a knife wound or swallowing something sharp

Although rare, accidents during specific medical procedures can also cause gastrointestinal perforation. Examples include:

endoscopy — a procedure that uses a small camera to look at the intestine

colonoscopy — a medical procedure that can diagnose bowel cancer

Symptoms

Severe abdominal pain and tenderness are symptoms of gastrointestinal perforation.

The primary symptoms of gastrointestinal perforation are severe abdominal pain and tenderness. The abdomen may also protrude or feel hard to the touch.

If the hole is in a person’s stomach or small intestine, the onset of pain is usually sudden, but if the hole is in the large bowel, the pain may come on gradually. In either case, once the pain starts, it is likely to be constant.

The pain may get worse when the person moves or if there is any pressure on the abdomen. However, it may lessen if they lay down.

Other symptoms of gastrointestinal perforation may include:

chills

fever

nausea

vomiting

If a person with gastrointestinal perforation develops peritonitis, the following symptoms may occur:

fatigue

going to the toilet less

shortness of breath

rapid heartbeat

dizziness

If peritonitis leads to sepsis, a person may experience:

increased heart rate

rapid breathing

fever

confusion

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When to see a doctor

If people experience any of the symptoms of gastrointestinal perforation or peritonitis they should see a doctor immediately.

Most cases of gastrointestinal perforation require emergency treatment. The situation is particularly urgent if a person has symptoms of sepsis, which is life-threatening.

Diagnosis

To diagnose the condition, the doctor may carry out one or more of the following tests:

X-ray of the chest and abdomen. This is to check for air in the abdominal cavity, a sign of gastrointestinal perforation.

CT scan. This helps the doctor to locate any possible holes.

Blood test. This is to check for signs of infection and possible blood loss.

Treatment

Gastrointestinal perforation can cause peritonitis and sepsis so emergency care is essential.

People with gastrointestinal perforation often require emergency surgery.

This will usually involve an exploratory laparotomy. The surgeon will open up the person’s abdomen and repair any holes in the gastrointestinal tract.

They will also remove any substances from the person’s stomach, small intestine, or large bowel that are now in the abdomen. This helps to treat the peritonitis and prevent sepsis.

For some people, it may be necessary to remove part of the intestine. This can lead to a person needing a colostomy or ileostomy. These procedures allow the contents of the person’s intestine to collect in a bag that attaches to their abdomen.

On rare occasions, a gastrointestinal perforation may heal on its own and not require surgery. If this occurs, a course of antibiotics may be the only treatment.

If a person has sepsis, they will require intravenous antibiotics as soon as possible.

Complications

Possible complications of gastrointestinal perforation include internal bleeding and sepsis. Gastrointestinal perforation can also lead to abdominal abscesses or permanent bowel damage. It may even cause part of the bowel to die.

Sometimes a person’s wounds might fail to heal following surgery, or they may develop an infection. Certain lifestyle factors may increase the risk of this, including smoking, drinking too much alcohol, and obesity.

There are also some medical conditions that can contribute to poor wound healing, including:

malnutrition

type 2 diabetes

hematoma

corticosteroid therapy

certain medications

Outlook

Gastrointestinal perforation is a serious condition with many different causes, some of which are more preventable than others.

If a person has any of the illnesses that may lead to gastrointestinal perforation, they should follow the treatment plan that their doctor advises. This reduces the risk of developing the condition.

As with any condition, the outlook improves with early diagnosis and treatment.

The size of the hole and the length of time before treatment may determine how successfully surgeons can repair the perforation. This will, in turn, affect the recovery.

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