Gastrointestinal Perforation

Gastrointestinal perforation refers to a hole that develops through the entire wall of the stomach, small intestine, large bowel, or rectum.

• Peptic ulcer disease: Most common cause of gastric and duodenal perforations.
• Diverticulitis: Common cause of colonic perforation.
• Trauma: Blunt or penetrating injuries.
• Foreign body ingestion.
• Ischaemic bowel disease.
• Inflammatory bowel disease: Crohn’s and Ulcerative Colitis.
• Cancer: Can cause perforation secondary to tumour invasion.
• Iatrogenic: Endoscopic procedures, surgeries.

• Severe, acute onset abdominal pain.
• Signs of peritonitis: Tenderness, guarding, rebound pain.
• Systemic signs: Fever, tachycardia, hypotension.
• Reduced or absent bowel sounds.
• Rigidity or “board-like” abdomen.

• Upright chest X-ray: To detect free intraperitoneal air (pneumoperitoneum).
• Abdominal X-ray: Can show free air under the diaphragm.
• CT scan of the abdomen: More sensitive in detecting free air and the site of perforation.
• Blood tests: White cell count (raised in infection), metabolic acidosis, and other markers of sepsis.

• Resuscitation: IV fluids, broad-spectrum antibiotics, and analgesia.
• Surgery: Emergency laparotomy or laparoscopy to locate and repair the perforation.
• Peritoneal lavage to remove contaminated material.
• Post-operative care with antibiotics, NG decompression, and supportive care.

• Peritonitis: Inflammation of the peritoneal lining.
• Sepsis and septic shock.
• Adhesions: Leading to bowel obstruction.
• Abscess formation.