The gastrointestinal tract consists of the stomach, small intestine, and large bowel. It is possible for a perforation, or hole, to develop in the wall of the gastrointestinal tract. This condition is called gastrointestinal perforation.
Gastrointestinal perforation is a painful condition that can lead to further health complications, so emergency surgery is often necessary.
This article explores the causes and symptoms of gastrointestinal perforation. It also covers complications, diagnosis, treatment, and when to see a doctor.
Gastrointestinal perforation is a hole in the wall of the gastrointestinal tract. Other names for the condition include:
- ruptured bowel
- intestinal perforation
- perforation of the intestines
Most people who have gastrointestinal perforation will have a hole in their stomach or small intestine.
A hole in the large bowel, also known as the lower intestine, occurs less frequently. Researchers estimate that perforations of the lower intestine only affect 4 in every 100,000 people in the European population.
A perforation can cause the contents of the stomach, small intestine, or large bowel to seep into the abdominal cavity. Bacteria will also be able to enter, potentially leading to a condition called peritonitis, which is life-threatening and requires immediate treatment.
People with a gastrointestinal perforation, therefore, need emergency medical care. Intestinal perforations are the most common surgical emergency that occurs worldwide.
Many different conditions can cause gastrointestinal perforation, including:
- volvulus — a bowel obstruction that happens when the large bowel becomes twisted
- colon cancer
- diverticulitis — an inflammatory condition that affects the large bowel
- peptic ulcers in the stomach or small intestine
- ischemic colitis — inflammation of the large bowel due to an inadequate supply of blood
- gallbladder infection
- inflammatory bowel disease
- reactions to nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen
- injury or trauma to the abdomen, such as a knife wound or swallowing something sharp
Although rare, accidents during specific medical procedures can also cause gastrointestinal perforation. Examples include:
The primary symptoms of gastrointestinal perforation are severe abdominal pain and tenderness. The abdomen may also protrude or feel hard to the touch.
If the hole is in a person's stomach or small intestine, the onset of pain is usually sudden, but if the hole is in the large bowel, the pain may come on gradually. In either case, once the pain starts, it is likely to be constant.
The pain may get worse when the person moves or if there is any pressure on the abdomen. However, it may lessen if they lay down.
Other symptoms of gastrointestinal perforation may include:
If a person with gastrointestinal perforation develops peritonitis, the following symptoms may occur:
- going to the toilet less
- shortness of breath
- rapid heartbeat
If peritonitis leads to sepsis, a person may experience:
- increased heart rate
- rapid breathing
If people experience any of the symptoms of gastrointestinal perforation or peritonitis they should see a doctor immediately.
Most cases of gastrointestinal perforation require emergency treatment. The situation is particularly urgent if a person has symptoms of sepsis, which is life-threatening.
To diagnose the condition, the doctor may carry out one or more of the following tests:
- X-ray of the chest and abdomen. This is to check for air in the abdominal cavity, a sign of gastrointestinal perforation.
- CT scan. This helps the doctor to locate any possible holes.
- Blood test. This is to check for signs of infection and possible blood loss.
People with gastrointestinal perforation often require emergency surgery.
This will usually involve an exploratory laparotomy. The surgeon will open up the person's abdomen and repair any holes in the gastrointestinal tract.
They will also remove any substances from the person's stomach, small intestine, or large bowel that are now in the abdomen. This helps to treat the peritonitis and prevent sepsis.
For some people, it may be necessary to remove part of the intestine. This can lead to a person needing a colostomy or ileostomy. These procedures allow the contents of the person's intestine to collect in a bag that attaches to their abdomen.
On rare occasions, a gastrointestinal perforation may heal on its own and not require surgery. If this occurs, a course of antibiotics may be the only treatment.
If a person has sepsis, they will require intravenous antibiotics as soon as possible.
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 a person'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.
There are also some medical conditions that can contribute to poor wound healing, including:
Gastrointestinal perforation is a serious condition with many different causes, some of which are more preventable than others.
If a person has any of the illnesses that may lead to gastrointestinal perforation, they should follow the treatment plan that their doctor advises. This reduces the risk of developing the condition.
As with any condition, the outlook improves with early diagnosis and treatment.
The size of the hole and the length of time before treatment may determine how successfully surgeons can repair the perforation. This will, in turn, affect the recovery.