Gastrointestinal Perforation

What Is Gastrointestinal Perforation?

Gastrointestinal perforation (GP) occurs when a hole forms all the way through the stomach, large bowel, or small intestine. It might be caused by a number of different diseases, including appendicitis, diverticulitis, or by trauma from a knife wound. A perforation may also occur in the gallbladder. The contents of these organs are then able to spill over into the abdominal cavity.

A hole in your gastrointestinal system can lead to peritonitis. Peritonitis is inflammation of the membrane that lines the abdominal cavity. It can occur if bacteria, bile or stomach acid enters the abdominal cavity.

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

The condition is also called intestinal perforation, or perforation of the intestines.

What Are the Causes of Gastrointestinal Perforation?

GP can be caused by illnesses such as:

  • appendicitis (more common among the elderly)
  • diverticulitis, a digestive disease
  • ulcer
  • gallstones or gallbladder infection
  • inflammatory bowel diseases such as Crohns disease or ulcerative colitis (less common)
  • inflamed Meckels diverticulum (a congenital abnormality of the small intestine that causes a bulge in the small intestine)

The condition may also be caused by:

  • blunt trauma to the stomach; blunt trauma occurs from injury, such as a car or bicycle accident (more common cause of GP among children than adults)
  • a knife wound to the stomach
  • abdominal surgery
  • taking aspirin, nonsteroidal anti-inflammatory drugs, and steroids (more common in the elderly)

According to the National Center for Biotechnology Information (NCBI), the risk of GP increases when the medication bevacizumab is used during cancer treatment. Risk varies depending on the dose of the drug and the type of tumor the drug is treating. (NCBI).

Rarely, the condition may occur from bowel injuries from an endoscopy or colonoscopy.

Symptoms of Gastrointestinal Perforation

Symptoms of GP may include:

  • severe stomach pain
  • chills
  • fever
  • nausea
  • vomiting

When peritonitis occurs, the abdomen feels very tender. Pain often worsens when the area is touched or palpated. The abdomen may stick outward farther than normal and feel hard.

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

  • exhaustion
  • passing less urine and/or stools or gas
  • shortness of breath
  • fast heartbeat

Diagnosis of Gastrointestinal Perforation

To diagnose GP, your healthcare provider will likely:

  • take X-rays of your chest or abdomen to check for air in the abdominal cavity
  • take a CT scan to look for the location of the hole
  • order a test for a white blood cell count (WBC). WBC may be higher than usual indicating inflammation or infection

Treatment of Gastrointestinal Perforation

In most cases, surgery is necessary to close the hole and treat the condition. According to Medscape (MS), the goals of surgery are:

  • to fix the anatomical problem
  • to fix the cause of peritonitis
  • to remove any foreign material in the abdominal cavity that might cause problems, such as feces, bile, food, etc. (MS)

In rare cases, if the hole has closed, your healthcare provider may forgo surgery and prescribe antibiotics alone.

Sometimes, a piece of the intestine will be removed. If this is done, a temporary colostomy is performed to allow stools to drain or empty into a bag that is attached to your abdominal wall.

Prognosis for Gastrointestinal Perforation

The success of the surgery depends on the size of the perforation or hole and the length of time before treatment. The chances of recovery improve with an early diagnosis and treatment. Factors that can hinder treatment include:

  • advanced age
  • existing bowel disease
  • bleeding complications
  • malnutrition
  • the nature of the original cause of the condition  

Complications of Gastrointestinal Perforation

Complications associated with GP include:

  • bleeding
  • sepsis, a life-threatening bacterial infection
  • abscesses in the belly
  • wound infection

Wound failure, in which the wound is disrupted and prevented from healing, may occur in some cases. Factors that increase this risk include:

  • malnutrition (poor diet)
  • sepsis
  • uremia, an illness caused by kidney failure
  • obesity
  • hematoma (blood that forms outside the blood vessels)
  • type 2 diabetes
  • therapy (a drug used to treat a rare blood disorder)
  • cortiocosteroids or steroid therapy (anti-inflammatory drugs that suppress the immune system and can mask and ongoing infection, delaying diagnosis)

Prevention of a Gastrointestinal Perforation

There are many causes of GP. An understanding of any underlying gastrointestinal disease that you might have that could increase you risk for perforation might be helpful. Any significant change from your baseline state, especially if you have abdominal pain and fever, should be addressed promptly..