What is Gastrointestinal Perforation?
Gastrointestinal perforation is a painful condition that occurs when hole develops in the wall of the gastrointestinal tract. The gastrointestinal tract consists of the stomach, small intestine, and large intestine.
Gastrointestinal perforation can lead to other health complications, so emergency surgery is often necessary.
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Gastrointestinal perforation, also called ruptured bowel is a hole in the wall of the gastrointestinal tract. Most people who have gastrointestinal perforation will have a hole in their stomach or small intestine.
A hole in the large bowel, also known as the lower intestine, occurs less frequently. A puncture can cause the contents of the small intestine, large bowel, or stomach to ooze into the abdominal cavity. Bacteria will also be able to enter, this can lead to a life-threatening condition called peritonitis, which requires immediate treatment.
Peritonitis is inflammation of the peritoneum, the thin layer of tissue that lines the abdomen. Without treatment, peritonitis can cause sepsis or blood poisoning. Sepsis may lead to organ failure.
Causes of Gastrointestinal Perforation?
Many different conditions can cause gastrointestinal perforation, including:
- Colon cancer
- Volvulus: This is a bowel obstruction that happens when the large bowel becomes twisted
- Diverticulitis: This is an inflammatory condition that affects the large bowel
- Peptic ulcers in the stomach or small intestine
- Ischemic colitis: This is an inflammation of the large bowel due to an inadequate supply of blood
- Gallbladder infection
- Inflammatory bowel disease
- reactions to nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen
- Injury or trauma to the abdomen, such as a knife wound or swallowing something sharp
Although rare, accidents during specific medical procedures can also cause gastrointestinal perforation. Examples include:
- Endoscopy: This a procedure that uses a small camera called endoscope to view at the intestine
- Colonoscopy: This is a medical procedure that can diagnose bowel cancer
Symptoms of Gastrointestinal Perforation
The primary symptoms of gastrointestinal perforation are severe abdominal pain and tenderness. The abdomen may also bulge or feel hard to the touch.
If the hole is in a person’s stomach or small intestine, the pain is usually sudden, but if the hole is in the large bowel, the pain may come on gradually. In either case, once the pain starts, it is likely to be constant.
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The pain may get deteriorate when the person moves or if there is any pressure on the abdomen. However, it may lessen if they lay down.
Other symptoms of gastrointestinal perforation may include:
- Nausea and vomiting
If a person with gastrointestinal perforation develops peritonitis, the following symptoms may occur:
- Less bowel movement: In this case, the person defecates less than usual
- Rapid heartbeat
If peritonitis leads to sepsis, a person may experience:
- Increased heart rate
- Rapid breathing
To diagnose the condition, the doctor may carry out one or more of the following tests:
- X-ray of the chest and abdomen. This test is to examine the abdomen for air in the abdominal cavity, which is a sign of gastrointestinal perforation.
- CT scan. This helps to locate any possible holes.
- Blood test. This is to check for signs of infection and possible blood loss.
Treatment of Gastrointestinal Perforation
People with gastrointestinal perforation often require emergency surgery that will usually involve an exploratory laparotomy. The surgeon will open up the person’s abdomen and repair any holes in the gastrointestinal tract.
They will also remove any substances from the person’s stomach, small intestine, or large bowel that are now in the abdomen. This helps to treat the peritonitis and prevent sepsis.
In some cases, it may be essential to remove part of the intestine. This can lead to a person needing a colostomy or ileostomy. These procedures allow the contents of the person’s intestine to gather in a bag that attaches to their abdomen.
On rare occasions, a gastrointestinal perforation may heal on its own and not require surgery. If this occurs, antibiotics may be administered to prevent infection.
Possible complications of gastrointestinal perforation include internal bleeding and sepsis. Gastrointestinal perforation can also lead to abdominal abscesses or permanent bowel damage. It may even cause part of the bowel to die.
In some cases, wounds might fail to heal after a surgery, or they may develop an infection. Lifestyle factors like obesity, excessive smoking or intake of alcohol, may be responsible if this happens.