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.