What is gastrointestinal
Gastrointestinal perforation (GP)
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:
- stomach acid
- partially digested food
GP 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.
What are the symptoms of
Symptoms of GP may include:
- severe stomach pain
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, symptoms of peritonitis may include:
- passing less urine, stools, or gas
- shortness of breath
- a fast heartbeat
What are the causes of
Illnesses can cause GP, including:
- appendicitis, which is more common among older
- diverticulitis, which is a digestive disease
- a stomach ulcer
- gallbladder infection
- inflammatory bowel diseases such as Crohn’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
- cancer in the gastrointestinal tract
The condition may also be due to:
- blunt trauma to the abdomen
- a knife or gunshot wound to the abdomen
- abdominal surgery
- stomach ulcers due to taking aspirin,
nonsteroidal anti-inflammatory drugs, and steroids (more common in older adults)
- ingestion of foreign objects or caustic
Smoking and excessive use of alcohol
increase your risk of GP.
Rarely, the condition may occur due to
bowel injuries from an endoscopy or colonoscopy.
How is gastrointestinal
To diagnose GP, your doctor will
likely take X-rays of your chest or abdomen 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. They’ll also order lab work to:
- look for signs of infection, such as a
high white blood cell count
- evaluate your hemoglobin level, which
can indicate if you have blood loss
- evaluate electrolytes
- evaluate acid level in the blood
- assess kidney function
- assess liver function
What are the treatment
options for 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 anatomical problem
- fix the cause of peritonitis
- remove any foreign material in the abdominal
cavity that might cause problems, such as feces, bile, and food
In rare cases, your doctor may forgo
surgery and prescribe antibiotics alone if the hole closed 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.
What are the complications
associated with gastrointestinal perforation?
Complications associated with GP
- sepsis, which is a life-threatening bacterial
- abscesses in the belly
- a wound infection
- a bowel infarction, which is the death of part of
- a 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:
- malnutrition, or poor diet
- excessive alcohol use
- drug abuse
- poor hygiene
- uremia, which is an illness caused by kidney
- hematoma, which occurs when blood collects
outside the blood vessels
- type 2 diabetes
- 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, rheumatoid arthritis
What is the long-term
The success of 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:
- advanced age
- existing bowel disease
- bleeding complications
- the nature of the original cause of the
- alcohol or drug abuse
- active treatment for cancer
requiring steroids or biologic agents including lupus, rheumatoid arthritis,
and similar conditions.
medical conditions such as heart disease, kidney or liver problems, and
If you experience pain or fever and
you’re at risk of having a GP, you should see your doctor. The sooner you see
your doctor, the better your outlook will be.
How can I prevent
There are many causes of GP. For
example, an underlying gastrointestinal disease can increase your risk for
perforation. Get to know your medical history and seek information on the
current conditions that might increase your risk.
Speak to a doctor if you experience
any significant change from your normal state, especially if you have abdominal
pain and fever.