Perforation of the intestines

Alternative names
Intestinal perforation; Gastrointestinal perforation

Definition
Gastrointestinal perforation occurs when the wall of the stomach, small intestine or large bowel develops a hole through its entire thickness. Perforation of the intestine leads to leakage of intestinal contents into the abdominal cavity. This causes an inflammation called peritonitis. Perforation anywhere along the gastrointestinal tract is a surgical emergency.

Causes, incidence, and risk factors

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

Symptoms

Severe abdominal pain, fevers, nausea, and vomiting can accompany perforation.

Signs and tests

X-rays of the abdomen may reveal air in the abdominal cavity, suggesting a perforation. CT scan of the abdomen often reveals the location of the perforation. The white blood cell (WBC) count 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 the case in patients whose perforations have sealed off, because they are not systemically ill. This is evident from physical exam, laboratory tests, and x-rays.

Expectations (prognosis)

Depending on the disease process and the length of time since the perforation occured, it 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 doctor for any severe abdominal pain, fevers, nausea, vomiting, or severe 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 doctor regarding treatment for diseases that can cause perforation.

Johns Hopkins patient information

Last revised: December 3, 2012
by Levon Ter-Markosyan, D.M.D.

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