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Gastrointestinal Perforation

by | May 6, 2022 | Info | 0 comments

Gastrointestinal Perforation Overview

A colon perforation is a puncture, cut, or tear in the wall of the colon or large intestine. This can cause air and intestinal material to leak into the abdomen.

Gastrointestinal perforation occurs when a hole forms all the way through the stomach, large bowel, or small intestine. It can be due to a number of different diseases, including appendicitis and diverticulitis. It can also be the result of trauma, such as a knife wound or gunshot wound. A perforation may also occur in the gallbladder.

This can have symptoms that are similar to the symptoms of a gastrointestinal perforation.

A hole in your gastrointestinal system or gallbladder can lead to peritonitis. Peritonitis is inflammation of the membrane that lines the abdominal cavity.

It occurs when any of the following enters the abdominal cavity:

  • Bacteria
  • Bile
  • Partially digested food
  • Stool
  • Stomach acid

Gastrointestinal perforation is a medical emergency that requires immediate medical care. The condition is life-threatening. Chances of recovery improve with early diagnosis and treatment.

This condition is also known as intestinal perforation or perforation of the intestines.

Signs and Symptoms of Gastrointestinal Perforation

Signs and symptoms of gastrointestinal perforation may include the following:

When you’ve had a gastrointestinal perforation and peritonitis occurs, the abdomen feels very tender. Pain often worsens when someone touches or palpates the area or when the patient moves. pain is generally better when lying still. The abdomen may stick outward farther than normal and feel hard.

In addition to the general symptoms of perforation, peritonitis may include the following symptoms:

Causes of Gastrointestinal Perforation

Several different conditions and diseases can cause gastrointestinal perforation, including the following:

  • A breakdown of the intestinal wall by infection or disease
  • Appendicitis, which is more common among older persons
  • Cancer of the gastrointestinal tract
  • Diverticulitis, which is a digestive disease
  • Stomach ulcers
  • Gallstones
  • Gallbladder infection
  • Inflammatory bowel disease (IBD) such as Chron’s disease or ulcerative colitis, which is less common
  • Inflamed Meckel’s diverticulum, which is a congenital abnormality of the small intestine that’s similar to the appendix 
  • Pressure against a weakened area of intestine
  • Trauma


Gastrointestinal perforation may also be caused due to the following conditions:

  • A knife or gunshot wound to the abdomen
  • Abdominal surgery
  • Blunt trauma to the abdomen
  • Ingestion of a foreign objects or caustic substances
  • Stomach ulcers due to taking aspirin, nonsteroidal anti-inflammatory drugs, and steroids (more common in older adults)

Smoking and excessive use of alcohol increase your risk of gastrointestinal perforation. Sometimes Gastrointestinal perforation may also occur due to bowel injuries from an endoscopy or colonoscopy, however this is rare.

Diagnosis of Gastrointestinal Perforation

A perforation may be seen during a procedure. Any problems that happen shortly after it may also be enough to suspect this health problem. Patients who have not had a recent procedure will be asked about their symptoms and health history. A physical exam will be done.

Several blood tests may be done to look for any signs of infection.

To diagnose gastrointestinal perforation, a doctor will likely take X-rays of the abdomen or chest to check for air in the abdominal cavity. They may also perform a CT scan to get a better idea where the perforation might be.

Following additional tests may also be performed by your doctor:

  • Assess kidney function
  • Check your hemoglobin level, which can indicate if you have blood loss
  • Evaluate electrolytes
  • Look for signs of infection, such as a high white blood cell count
  • Check the acid level in the blood
  • Assess liver function

Treatment of Gastrointestinal Perforation

In most cases, surgery is necessary to close the hole and treat the condition. The goals of the surgery are to:

  • Fix the cause of peritonitis
  • Repair the anatomical problem
  • Remove any foreign material in the abdominal cavity that might cause problems, such as feces, bile, and food

In some rare cases, your doctor may forgo surgery and prescribe antibiotics alone if the hole closes on its own.

Sometimes, a piece of the intestine will need removal. The removal of a portion of either the small or large intestine may result in a colostomy or ileostomy, which allows intestinal contents to drain or empty into a bag attached to your abdominal wall.


Complications of Gastrointestinal Perforation

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 the patient’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.

Following are complications associated with gastrointestinal perforation:

  • A wound infection
  • Abscesses in the belly
  • Bowel infarction, which is the death of part of the bowel
  • Bleeding
  • Sepsis, which is a life-threatening bacterial infection
  •  Permanent ileostomy or colostomy

Wound failure may occur in some cases. “Wound failure” means the wound can’t or doesn’t heal. Factors that increase the risk of this include:

  • Diabetes
  • Drug abuse
  • Excessive alcohol use
  • Hematoma, which occurs when blood collects outside the blood vessels
  • Malnutrition, or poor diet
  • Obesity
  • Poor hygiene
  • Smoking
  • Sepsis
  • Steroid therapy or the use of corticosteroids, which are anti-inflammatory drugs that suppress the immune system and can mask an ongoing infection and delay diagnosis
  • The use of biologic agents for conditions such as Crohn’s disease, ulcerative colitis and rheumatoid arthritis
  • Type 2 diabetes
  • Uremia, which is an illness caused by kidney failure

Prevention of Gastrointestinal Perforation

There are many causes of gastrointestinal perforation. For example, an underlying gastrointestinal disease can increase your risk for gastrointestinal perforation . It is important to get to know the patients medical history and seek information on the current conditions that might increase the risk of developing gastrointestinal perforation.

Patients must consult with their doctor if they experience any significant change from their normal state, especially if they are experiencing abdominal pain and fever.

Management of Gastrointestinal Perforation

‌Gastrointestinal perforation is a serious condition that may require emergency surgery. Early detection and treatment are crucial for reducing its effects on the gastrointestinal system. Late-stage diagnosis could lead to death.‌‌

Management also involves the treatment of any infection caused by the perforation. Your doctor may treat sepsis using fluids and antibiotic medication.

Surgery is effective in repairing the perforation. The success of treatment by surgery depends on the following conditions:‌

  • The severity of the perforation: The less severe your condition is, the higher the chances of success.
  • How long the perforation has been there: A gastrointestinal perforation that has existed for a long time may be harder to manage.
  • Presence of underlying medical conditions: Other underlying conditions like asthma can make the treatment more complicated.

A doctor may perform a colostomy. This procedure involves emptying the stomach and putting its contents into a bag. This process is also called an ileostomy. ‌

‌The bowel contents are emptied through a hole (stoma) created in your abdomen. This gives more time to the other parts of your gastrointestinal tract to heal. The hole is later repaired through surgery.

After the surgery, the doctor may give you some antibiotics. These will help in managing and preventing infections.


Prognosis of Gastrointestinal Perforation

Successful surgery to repair a perforation depends on the size of the perforation or hole and the length of time before treatment.

The chances of recovery improve with early diagnosis and treatment. Factors that can hinder treatment include the following:

If the patient experience pain or fever and they are at risk of having a gastrointestinal perforation, the sooner you see your doctor, the better your outlook will be.

 

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