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.
