Gastrointestinal perforation (GP) is a condition, usually considered as a medical emergency which requires urgent medical attention. Gastrointestinal perforation occurs when there occurs a hole in the stomach extending to large bowel or the small intestine. Many conditions including ulcers, appendicitis and diverticulitis can cause gastrointestinal perforation.
What Can Cause Gastrointestinal Perforation?
Gastrointestinal perforation is considered to be a life threatening condition. However, timely diagnosis and appropriate treatment can help to manage the condition well.
Some causes of gastrointestinal perforation that can lead to a hole in the abdominal cavity include:
- Appendicitis – One of the common causes of gastrointestinal perforation is appendicitis. Appendix is a small pouch attached to the large intestine. Appendicitis is the inflammation of the appendix, causing swelling, fever and severe pain in the area.
- Crohn’s Disease – This is an autoimmune condition, in which the body’s immune system attacks the own tissues and affects the gastrointestinal tract. This can cause inflammation of the entire gastrointestinal tract, including small and large intestine. If condition worsens, it can cause gastrointestinal perforation.
- Peptic Ulcers – Ulcers in the stomach and small intestine are known to rupture and cause gastrointestinal perforation as a complication. Peptic ulcers often result from excessive consumption of aspirin, inflammatory drugs or steroids, excessive secretion of gastric acid or bacterial infections.
- Infections – Certain infections that affect the gastrointestinal tract, too can cause gastrointestinal perforation, if not treated appropriately.
- Trauma – Trauma to the abdomen due to minor or major injuries can cause gastrointestinal perforation. Ingestion of any kind of foreign objects or substances within the body too can cause injuries in the abdomen and lead to gastrointestinal perforation.
- Others – Other causes of gastrointestinal perforation can also include impaction of stool, indigested food, disorders of the gallbladder, inflammation of stones in gall bladder and cancer in gastrointestinal tract. Smoking or consumption of alcohol in excess might also cause GP.
Symptoms of Gastrointestinal Perforation
Some of the common symptoms of gastrointestinal include severe pain in abdomen. This is mostly accompanied with nausea, vomiting chills and sometimes fever with chills.
The major signs of gastrointestinal perforation, include a tender and very sensitive abdomen. The abdominal pain is often unbearable and worsens with movement or slightest touch. Symptoms like less urine or stool, severe trauma or bleeding, faster heartbeat or feeling short of beat or dizziness may be serious and must be reported immediately.
Thus, it is recommended that in such an acute abdominal condition, it is important to remain still to avoid further problems and immediate medical help must be sought.
Diagnosis of Gastrointestinal Perforation
Acute symptoms may raise the possibility of gastrointestinal perforation. While immediate medical help begins, it is important to note the history of the person. Clinical examination can reveal important signs of gastrointestinal perforation. For diagnosis of gastrointestinal perforation scans like abdomen and chest X-rays and CT scans maybe ordered. Any other investigation may be advised if found appropriate after history and examination.
Blood tests may be done to rule out infections and other medical conditions, which can aid in diagnosis of gastrointestinal perforation. These include:
- Detecting presence of infection, raised white blood cell count or changes in any other parameters.
- Checking hemoglobin level, to know if there has been any blood loss.
- Testing acid level in the blood, if required.
- Assessing kidney and liver function with appropriate tests.
How is Gastrointestinal Perforation Treated?
Immediate medical help is essential to stabilize the patient, following which necessary treatment for the underlying cause of gastrointestinal perforation is planned. Some cases may be managed well with medical treatment for gastrointestinal perforation, which mainly includes antibiotics and other specific medicines.
In some cases, the treatment for gastrointestinal perforation is surgery to repair the hole or perforation. Timely repair can help to regain the function and recovery from gastrointestinal perforation is possible.
The goals of surgery for gastrointestinal perforation include:
- Repair of the structural defect and problem leading to perforation.
- Removal of any foreign material, growth or other problem in the abdominal cavity that led to gastrointestinal perforation.
- Treating the cause of gastrointestinal perforation.
Certain complications of gastrointestinal perforation may include bleeding, infection in the wound or sepsis, which is considered as a life threatening infection and needs to be managed effectively.
Surgery for treatment of gastrointestinal perforation is often successful depending on the severity of the condition and any complications that occurred prior to the treatment. Further medications and lifestyle measures may be advised to aid in healthy recovery.
- Mayo Clinic. (2021). Perforated bowel. https://www.mayoclinic.org/diseases-conditions/perforated-bowel/symptoms-causes/syc-20375356
- National Institute of Diabetes and Digestive and Kidney Diseases. (2020). Crohn’s Disease. https://www.niddk.nih.gov/health-information/digestive-diseases/crohns-disease
- Mayo Clinic. (2021). Peptic ulcers. https://www.mayoclinic.org/diseases-conditions/peptic-ulcer/symptoms-causes/syc-20354223