Gastrointestinal perforation

Gastrointestinal perforation, also known as gastrointestinal rupture, is a hole in the wall of the gastrointestinal tract. The gastrointestinal tract is composed of hollow digestive organs leading from the mouth to the anus. Symptoms of gastrointestinal perforation commonly include severe abdominal pain, nausea, and vomiting. Complications include a painful inflammation of the inner lining of the abdominal wall and sepsis.

Perforation may be caused by trauma, bowel obstruction, diverticulitis, stomach ulcers, cancer, or infection. A CT scan is the preferred method of diagnosis; however, free air from a perforation can often be seen on plain X-ray.

Perforation anywhere along the gastrointestinal tract typically requires emergency surgery in the form of an exploratory laparotomy. This is usually carried out along with intravenous fluids and antibiotics. Occasionally the hole can be sewn closed while other times a bowel resection is required. Even with maximum treatment the risk of death can be as high as 50%. A hole from a stomach ulcer occurs in about 1 per 10,000 people per year, while one from diverticulitis occurs in about 0.4 per 10,000 people per year.

Gastrointestinal perforation results in sudden, severe abdominal pain at the site of perforation, which then spreads across the abdomen. The pain is intensified by movement. Nausea, vomiting, hematemesis, and increased heart rate are common early symptoms. Later symptoms include fever and or chills. On examination, the abdomen is rigid and tender. After some time, the bowel stops moving, and the abdomen becomes silent and distended.

The symptoms of esophageal rupture may include sudden onset of chest pain.

A hole in the intestinal tracts allows intestinal contents to enter the abdominal cavity. The entry of bacteria from the gastrointestinal tract into the abdomen results in peritonitis or in the formation of an abscess.

Patients may develop sepsis, a life-threatening response to infection, which may appear as an increased heart rate, increased breathing rate, fever, and confusion. This may progress to multi-level organ dysfunction, including acute respiratory and kidney failure.

Posterior gastric wall perforation may lead to bleeding due to the involvement of gastroduodenal artery that lies behind the first part of the duodenum. The death rate in this case is 20%.