Intestinal Perforation

Overview

Intestinal perforation is a medical and surgical emergency. It occurs when a hole forms all the way through the wall of the gastrointestinal tract, such as the stomach, small intestine, or colon. This allows the contents of the digestive tract, including food, digestive juices, and bacteria, to leak into the normally sterile abdominal cavity.

This leakage rapidly causes inflammation and infection of the lining of the abdomen, a condition called peritonitis, and can lead to severe, body-wide infection. Without prompt treatment, intestinal perforation can be fatal. It can result from many different conditions, and the key to survival is recognizing the warning signs and getting emergency care quickly.

Symptoms

Symptoms usually come on suddenly and are severe. They include:

• Sudden, severe, and constant abdominal pain
• A rigid, hard, and very tender abdomen
• Pain that worsens with movement
• Fever and chills
• Nausea and vomiting
• Rapid heartbeat and rapid breathing
• Feeling faint, dizzy, or confused

These symptoms are an emergency. As infection spreads, blood pressure can fall and the person can become critically ill very quickly. Sudden severe abdominal pain should never be ignored.

Causes

Many conditions can weaken or break through the bowel wall, leading to perforation. Common causes include:

• Peptic ulcers: A deep peptic ulcer can erode through the stomach or duodenal wall.
• Appendicitis and diverticulitis: A burst appendix or an inflamed colon pouch (diverticulitis).
• Bowel obstruction: A severely blocked or overstretched bowel.
• Inflammatory and infectious diseases: Such as severe colitis or toxic megacolon.
• Injury: Trauma to the abdomen, or rarely an injury during a medical procedure.
• Tumors: Cancers that erode the bowel wall.

Risk Factors

• A history of peptic ulcers or heavy NSAID use
• Diverticular disease or appendicitis
• Inflammatory bowel disease and severe colon inflammation
• Recent abdominal surgery or endoscopic procedures
• Abdominal trauma
• Older age and a weakened immune system

Diagnosis

Because perforation is an emergency, diagnosis is made quickly using examination and imaging:

• Physical examination: A rigid, tender abdomen strongly suggests perforation and peritonitis.
• Imaging: An upright chest or abdominal X-ray may show free air under the diaphragm, and a CT scan can pinpoint the location and cause.
• Blood tests: To assess infection, inflammation, and overall condition.

Treatment is often started immediately, even as testing continues, because delay increases the risk of serious complications.

Treatment

Intestinal perforation almost always requires urgent treatment, usually surgery:

• Emergency surgery: To close the hole, remove or repair damaged bowel, and clean out leaked contents and infection from the abdomen.
• Antibiotics: Strong intravenous antibiotics to treat and prevent the spread of infection.
• Intravenous fluids and supportive care: To stabilize blood pressure and support the body.
• Bowel rest: Stopping oral intake, sometimes with a tube to empty the stomach.

In some cases a temporary opening of the bowel onto the abdomen (stoma) is created to allow healing. Recovery depends on how quickly treatment is started and the underlying cause.

Because leaked intestinal contents can quickly cause severe, body-wide infection, the speed of treatment strongly affects the outcome. After surgery, people are often monitored closely, sometimes in intensive care, while the infection is brought under control and the bowel begins to heal. Once stable, the underlying condition that caused the perforation, such as an ulcer or diverticular disease, also needs to be treated to reduce the chance of it happening again. The length of recovery and the need for any further surgery depend on the cause, the amount of contamination in the abdomen, and the person's overall health.

Prevention

• Treat conditions such as peptic ulcers, diverticulitis, and appendicitis promptly
• Use NSAID painkillers carefully and with stomach protection if needed long-term
• Seek early care for severe or worsening abdominal pain
• Manage inflammatory bowel disease and follow medical advice during flares
• Follow post-procedure instructions after any bowel surgery or endoscopy

When to See a Doctor

Call emergency services or go to an emergency department immediately if you have:

• Sudden, severe, constant abdominal pain
• A hard, rigid, very tender belly
• Fever, vomiting, and a racing heartbeat with abdominal pain
• Feeling faint, very weak, or confused

Intestinal perforation is life-threatening, and survival depends on rapid treatment. Do not wait to see if the pain passes.

Related Topics

Frequently Asked Questions

References

1. MedlinePlus, U.S. National Library of Medicine. Gastrointestinal perforation.
2. Mayo Clinic. Peritonitis.
3. National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Digestive diseases.
4. Centers for Disease Control and Prevention (CDC). Sepsis.