Causes and treatment of gastrointestinal perforation

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.

What is gastrointestinal perforation?

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.

Peritonitis is inflammation of the peritoneum, the thin layer of tissue that lines the abdomen. Without treatment, peritonitis can cause blood poisoning, or sepsis. Sepsis may lead to organ failure.

People with a gastrointestinal perforation, therefore, need emergency medical care. Intestinal perforations are the most common surgical emergency that occurs worldwide.

Causes

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

·         gallstones

·         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:

·         endoscopy — a procedure that uses a small camera to look at the intestine

·         colonoscopy — a medical procedure that can diagnose bowel cancer

Symptoms

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:

·         chills

·         fever

·         nausea

·         vomiting

If a person with gastrointestinal perforation develops peritonitis, the following symptoms may occur:

·         fatigue

·         going to the toilet less

·         shortness of breath

·         rapid heartbeat

·         dizziness

If peritonitis leads to sepsis, a person may experience:

·         increased heart rate

·         rapid breathing

·         fever

·         confusion

When to see a doctor

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.

Diagnosis

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.

Source: Medical News Today