Gastrointestinal perforation
Gastrointestinal perforation, also known as gastrointestinal rupture, is a hole in the wall of the gastrointestinal tract. The gastrointestinal tract is composed of hollow digestive organs leading from the mouth to the anus. Symptoms of gastrointestinal perforation commonly include severe abdominal pain, nausea, and vomiting. Complications include a painful inflammation of the inner lining of the abdominal wall and sepsis.
| Gastrointestinal perforation | |
|---|---|
| Other names | Ruptured bowel, gastrointestinal rupture |
| Free air under the right diaphragm from a perforated bowel. | |
| Specialty | Gastroenterology, emergency medicine |
| Symptoms | Abdominal pain, tenderness |
| Complications | Sepsis, abscess |
| Usual onset | Sudden or more gradual |
| Causes | Trauma, following colonoscopy, bowel obstruction, colon cancer, diverticulitis, stomach ulcers, ischemic bowel, C. difficile infection |
| Diagnostic method | CT scan, plain X-ray |
| Treatment | Emergency surgery in the form of an exploratory laparotomy |
| Medication | Intravenous fluids, antibiotics |
Perforation may be caused by trauma, bowel obstruction, diverticulitis, stomach ulcers, cancer, or infection. A CT scan is the preferred method of diagnosis; however, free air from a perforation can often be seen on plain X-ray.
Perforation anywhere along the gastrointestinal tract typically requires emergency surgery in the form of an exploratory laparotomy. This is usually carried out along with intravenous fluids and antibiotics. Occasionally the hole can be sewn closed while other times a bowel resection is required. Even with maximum treatment the risk of death can be as high as 50%. A hole from a stomach ulcer occurs in about 1 per 10,000 people per year, while one from diverticulitis occurs in about 0.4 per 10,000 people per year.