Gastro-intestinal Perforation

Introduction

Gastro-intestinal perforation describes where a hole forms somewhere in the gastrointestinal tract, from the oesophagus connecting the mouth to the stomach, to the stomach itself and the small and large intestine. In most cases the perforation will be either in the stomach or the small intestine, with perforations in the large intestine less common.

The condition may also be referred to as a 'ruptured bowel' or an 'intestinal perforation'. The condition can lead to peritonitis (inflammation of the peritoneum – the lining of the abdominal cavity) which can in turn cause organ failure and death, so gastro-intestinal perforation is regarded as a medical emergency.

Symptoms

The following symptoms may be indicative of a gastro-intestinal perforation:

Pain

Sudden pain in the chest or abdomen. Generally the pain, which can be severe, starts at the site of the perforation and spreads across the abdomen. It is usually worse with movement. Perforation of the large intestine tends to cause a more gradual increase in pain compared to the sudden onset of pain where the perforation is in the stomach or small intestine. In all cases pain becomes constant

Other (later) symptoms

  • Increasingly rigid, and sometimes bloated and / or tender abdomen.
  • Feeling very unwell.
  • Nausea / vomiting.
  • Fever / chills.

If peritonitis has developed, this may also cause:

  • Cessation of bowel movements, urination, abdominal sounds and flatulence.
  • Shortness of breath / fatigue.
  • Dizziness.
  • Rapid heartbeat.

If any of these symptoms develop, it is important to seek medical assistance urgently.

Causes

Gastrointestinal perforation can be caused by underlying illness or by trauma.

Types of trauma include:

  • Knife / gunshot wound to abdomen.
  • Other blunt trauma to abdomen e.g. a car accident, falling off bikes.
  • Ingestion of sharp objects, small magnets (if they stick together through adjacent sections of intestine), acidic / caustic / corrosive substances.
  • Surgical injury, including injury during gastroscopy or colonoscopy (this is very rare).

Types of illness include:

Smoking, excess alcohol intake, drug abuse, type 2 diabetes and malnutrition also increase the risk of developing gastro-intestinal perforation.

Tests & Diagnosis

Early diagnosis of a gastrointestinal perforation is crucial to successful treatment. Tests that are used to diagnose the condition include:

  • Chest / abdomen x-ray.
  • CT scan.
  • Blood tests.

Treatment

In most cases gastrointestinal perforation requires emergency surgery.