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    Gastrointestinal perforation

    Intestinal perforation; Perforation of the intestines

    Gastrointestinal perforation is a hole that develops through thewhole wall of the esophagus, stomach, small intestine, large bowel, rectum, or gallbladder. This condition is a medical emergency.

    Causes

    Gastrointestinal perforation can be caused by a variety of illnesses. These include:

    • Appendicitis
    • Cancer
    • Crohn's disease
    • Diverticulitis
    • Gallbladder disease
    • Pepticulcer disease
    • Ulcerative colitis

    It may also be caused by abdominal surgery.

    Symptoms

    Perforation of the intestine causes the contents of the intestines to leak into the abdominal cavity. This causes a serious infection called peritonitis.

    Symptoms may include:

    • Abdominal pain - severe
    • Chills
    • Fever
    • Nausea
    • Vomiting

    Exams and Tests

    X-rays of the chest or abdomen may show air in the abdominal cavity, called free air. This is a sign ofa tear (perforation).

    A CT scan of the abdomen often shows the location of the perforation. The white blood cellcount is often higher than normal.

    Treatment

    Treatment usually involves surgery to repair the hole (perforation). Sometimes, a small part of the intestine must be removed. A temporary colostomy or ileostomy (to drain the small or large intestine) may be needed.

    In rare cases, antibiotics alone can be used to treat patients whose perforations have closed. This can be confirmed by a physical examination, blood tests, CT scan, and x-rays.

    Outlook (Prognosis)

    Surgery is usually successful. However, the success of surgery depends on how severe the perforation is, and for how long it waspresent before treatment.

    Possible Complications

    The most common serious complication of perforation, even with surgery, is infection. Infections can be either inside the abdomen (abdominal abscess), or throughout the whole body. Body-wide infection is calledsepsis. It can be very seriousandcan lead to death.

    When to Contact a Medical Professional

    Call yourhealth care providerif you have:

    • Blood in your stool
    • Changes in bowel habits
    • Fever
    • Nausea
    • Severe abdominal pain
    • Vomiting

    Prevention

    Oftenpeople will have a few days of pain before the intestinal perforation occurs. If you have pain in the abdomen, see your health care provider immediately. Treatment is much simpler and safer whenit is givenbefore the perforation occurs.

    References

    Turnage RH, Badgwell B. Abdominal wall, umbilicus, peritoneum, mesenteries, omentum, and retroperitoneum. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 19th ed. St. Louis, Mo: WB Saunders; 2012:chap 45.

    Wyers SG, Matthews JB. Surgical peritonitis and other diseases of the peritoneum, mesentery, omentum, and diaphragm. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger & Fordtran's Gastrointestinal and Liver Disease. 9th ed. Philadelphia, Pa: Saunders Elsevier; 2010:chap 37.

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    • Digestive system

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    • Digestive system organs

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      • Digestive system

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      • Digestive system organs

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      A Closer Look

        Self Care

          Tests for Gastrointestinal perforation

            Review Date: 7/25/2012

            Reviewed By: Jacob L. Heller, MD, MHA, Emergency Medicine, Virginia Mason Medical Center, Seattle, Washington, Clinic; and Joshua Kunin, MD, Consulting Colorectal Surgeon, Zichron Yaakov, Israel. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M. Health Solutions, Ebix, Inc.

            The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
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