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Gastrointestinal perforation

Definition
  • Gastrointestinal perforation refers to a hole that develops through the entire wall of the stomach, small intestine, large bowel, or rectum.
Etiology
  • 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.
  • Ischemic bowel disease.
  • Inflammatory bowel diseases: Crohn’s and Ulcerative Colitis.
  • Cancer: Can cause perforation secondary to tumour invasion.
  • Iatrogenic: Endoscopic procedures, surgeries.
Clinical Presentation
  • 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.
Investigations
  • 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.
Management
  • Resuscitation: IV fluids, broad-spectrum antibiotics, and analgesia.
  • Surgery: Emergent 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.
Complications
  • Peritonitis: Inflammation of the peritoneal lining.
  • Sepsis and septic shock.
  • Adhesions: Leading to bowel obstruction.
  • Abscess formation.

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