Drexel University College of Medicine

Diseases and Conditions

Gastrointestinal perforation

Definition

Gastrointestinal perforation is a hole that develops through the entire wall of the stomach, small intestine, large bowel, or gallbladder. This condition is a medical emergency.

Alternative Names

Causes, incidence, and risk factors

Gastrointestinal perforation can be caused by a variety of illnesses, including appendicitis, diverticulitis, ulcer disease, gallstones or gallbladder infection, and less commonly, inflammatory bowel disease, including Crohn's disease and ulcerative colitis.

Perforation of the intestine leads to leakage of intestinal contents into the abdominal cavity. This causes an inflammation called peritonitis.

Symptoms

Symptoms may include:

• Abdominal pain - severe
• Chills
• Fever
• Nausea
• Vomiting

Signs and tests

X-rays of the abdomen may show air in the abdominal cavity (not in the stomach or intestines), suggesting a perforation. CT scan of the abdomen often shows the location of the perforation. The person's white blood cell (WBC) count is often higher than normal.

Treatment

Treatment usually involves surgery to repair the hole (perforation). Occasionally, a small part of the intestine must be removed. A temporary colostomy or ileostomy may be needed.

In rare cases, antibiotics alone can be used to treat patients whose perforations have closed. This can be confirmed by a physical exam, blood tests, CT scan, and x-rays.

Expectations (prognosis)

Surgery is usually successful, but depends on the severity of the perforation and the length of time to treatment.

Complications

Complications include:

• Bleeding
• Infection (possible, sepsis)
• Intra-abdominal abscess

Calling your health care provider

Call your doctor if you have severe abdominal pain, fever, nausea, vomiting, blood in your stool, or changes in bowel habits.

Prevention

Prevention depends on the cause. Diseases that may lead to intestinal perforation should be treated appropriately.

References

Turnage RH, Richardson KA, Li BD, McDonald JC. Abdominal wall, umbilicus, peritoneum, mesenteries, omentum, and retroperitoneum. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 18th ed. St. Louis, Mo: WB Saunders; 2008:chap 43.

Physician Reference

International Classification of Diseases, 9^th Revision (ICD9)

A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org). URAC's accreditation program is an independent audit to verify that A.D.A.M. follows rigorous standards of quality and accountability. A.D.A.M. is among the first to achieve this important distinction for online health information and services. Learn more about A.D.A.M.'s editorial policy, editorial process and privacy policy. A.D.A.M. is also a founding member of Hi-Ethics and subscribes to the principles of the Health on the Net Foundation (www.hon.ch).

The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only - they do not constitute endorsements of those other sites. Copyright 2009 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.