Gastrointestinal perforation (GP) occurs when a hole forms all the way through the stomach, large bowel, or small intestine. It might be caused by a number of different diseases, including appendicitis, diverticulitis, or by trauma from a knife wound. A perforation may also occur in the gallbladder. The contents of these organs are then able to spill over into the abdominal cavity. A hole in your gastrointestinal system can lead to peritonitis. Peritonitis is inflammation of the membrane that lines the abdominal cavity. It can occur if bacteria, bile or stomach acid enters the abdominal cavity. GP is a medical emergency that requires immediate medical care. The condition is life threatening. Chances of recovery improve with an early diagnosis and treatment. The condition is also called intestinal perforation, or perforation of the intestines.
GP can be caused by illnesses such as:
appendicitis (more common among the elderly)
diverticulitis, a digestive disease
gallstones or gallbladder infection
inflammatory bowel diseases such as Crohn’s disease or ulcerative colitis (less common)
inflamed Meckel’s diverticulum (a congenital abnormality of the small intestine that causes a bulge in the small intestine)
The condition may also be caused by:
blunt trauma to the stomach; blunt trauma occurs from injury, such as a car or bicycle accident (more common cause of GP among children than adults)
a knife wound to the stomach
taking aspirin, nonsteroidal anti-inflammatory drugs, and steroids (more common in the elderly)
According to the National Center for Biotechnology Information (NCBI), the risk of GP increases when the medication bevacizumab is used during cancer treatment. Risk varies depending on the dose of the drug and the type of tumor the drug is treating.
Symptoms of GP may include:
severe stomach pain
When peritonitis occurs, the abdomen feels very tender. Pain often worsens when the area is touched or palpated. The abdomen may stick outward farther than normal and feel hard.
In addition to the general symptoms of perforation, symptoms of peritonitis may include:
passing less urine and/or stools or gas
shortness of breath
To diagnose GP, your healthcare provider will likely:
take X-rays of your chest or abdomen to check for air in the abdominal cavity
take a CT scan to look for the location of the hole
order a test for a white blood cell count (WBC). WBC may be higher than usual indicating inflammation or infection
In most cases, surgery is necessary to close the hole and treat the condition. According to Medscape, the goals of surgery are:
to fix the anatomical problem
to fix the cause of peritonitis
to remove any foreign material in the abdominal cavity that might cause problems, such as feces, bile, food, etc.
In rare cases, if the hole has closed, your healthcare provider may forgo surgery and prescribe antibiotics alone.