- Causes: Small bowel perforation can result from various factors including trauma, such as blunt or penetrating injuries, gastrointestinal diseases like Crohn’s disease or diverticulitis, infections like tuberculosis or typhoid fever, ischemia due to reduced blood supply, complications of abdominal surgery, and ingestion of foreign bodies.
- Presentation: Patients with small bowel perforation may present with acute abdominal pain, tenderness, rigidity, distension, nausea, vomiting, fever, and signs of peritonitis such as guarding and rebound tenderness. In some cases, patients may also experience symptoms related to the underlying cause of perforation.
- Investigation: Diagnostic evaluation typically involves imaging studies such as computed tomography (CT) scans with oral and intravenous contrast to visualize the perforation site, assess for complications like abscess formation, and identify the underlying cause. Other investigations may include laboratory tests and diagnostic peritoneal lavage in unstable patients.
- Diagnosis: Diagnosis of small bowel perforation is confirmed based on clinical evaluation, imaging findings consistent with perforation, and sometimes intraoperative findings if surgery is indicated. Identification of the precise cause of perforation is essential for appropriate management.
- Treatment: Treatment of small bowel perforation involves a multidisciplinary approach including initial resuscitation, intravenous antibiotics to cover likely pathogens, and emergent surgical intervention to repair the perforation, remove any necrotic tissue, and address complications such as peritonitis or abscess formation. In stable patients with contained perforations, conservative management with bowel rest, antibiotics, and close monitoring may be considered.
Gastrointestinal perforation is a hole that develops through the walls of the GI tract. Any part of the GI tract can be perforated starting from the wall of the esophagus, the stomach, small intestine, large bowel, rectum or the gall bladder. The gastric or intestinal contents released spill into the peritoneal space. Peritonitis or inflammation of the membrane lining the abdominal cavity is caused due to GI tract perforation. The onset of gastrointestinal perforation is always sudden and is deemed as a medical emergency.n Tumors: When the mass of cells are not life-threatening and lack the capability to metastize or invade other neighboring tissues, they are called benign tumors. Usually this mass or lump is evident and can be felt from outside.
gastrointestinal perforation causes
- Inflammatory bowel disease like ulcerative colitis and Crohn’s diease
- Gastrointestinal cancer
- Superior mesenteric artery syndrome
- Diverticulitis
- Appendicitis
- Gastric ulcer
- Peptic ulcer disease
- Blunt trauma to the stomach
- Knife and stab wounds to the stomach
- Intake of non-steroidal anti-inflammatory drugs, steroids and aspirin
- Cancer treatment drugs such as bevacizumab
- Bowel injuries due to endoscopy or colonoscopy
Gastrointestinal Perforation Symptoms
- Severe abdominal pain
- Chills
- Fever
- Nausea
- Vomiting
- Heavy to medium rectal bleeding
- Symptoms of peritonitis such as exhaustion, shortness of breath, rapid heartbeat and passing less urine, stools and gas
Gastrointestinal Perforation Diagnosis
Abdominal series: Supine and upright x-rays of the chest and abdomen are ordered to check for air in the abdominal cavity. Free air is shown under the diaphragm in the abdominal cavity if there is a hole in the intestine. Lateral chest x-rays are more effective in detecting free air than posteroanterior x-rays.
CT scan: The computed tomography shows the exact location of the hole in the intestine. This is usually done when the abdominal series is non-conclusive. An abdominal CT scan with IV and rectal contrast may be done. Barium is usually not done if a perforation of the intestine is suspected.
WBC :A white blood cell count is taken to assess elevation of white blood cells, indicating infection and inflammation.
Treatment is surgical. Bowel perforation is a surgical emergency. If not operated on time the patient may go into severe sepsis and multi-organ failure.