(See also Overview of Gastrointestinal Emergencies.)
A perforation allows food, digestive juices, or other intestinal contents to leak into the abdomen (or sometimes the chest, if the esophagus is perforated). These materials are very irritating and contain bacteria, which cause severe inflammation and infection that are typically fatal if untreated.
Causes
Causes of perforation of the digestive tract vary depending on the location of the perforation, but injury can affect any part of the digestive system. Swallowed foreign bodies usually pass through a person without difficulty but occasionally become stuck and lead to perforation. Foreign bodies inserted through the anus may perforate the rectum or colon.
Some Causes of Perforation
Area of Perforation |
Causes |
Comments |
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Anywhere along the digestive tract |
Injury |
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Forceful vomiting |
This disorder is called Boerhaave syndrome. |
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Injury caused by a medical procedure |
Injury is typically caused by an esophagoscope, balloon dilator, or bougie (a thin cylinder-shaped instrument). |
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Swallowing strong corrosive material |
Typically, battery acid or lye is swallowed. |
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Stomach or the first segment of the small intestine (duodenum) |
About one third of people have had no previous ulcer symptoms. |
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Swallowing strong corrosive material |
Such material typically damages the stomach rather than the small intestine. |
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A blockage that cuts off the blood supply to the intestine (strangulating obstruction) |
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Possibly appendicitis and Meckel diverticulitis |
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A blockage (obstruction) |
Blockage typically results from cancer or impacted stool. |
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People who are taking prednisone or other drugs that inhibit the immune system (immunosuppressants) are at high risk of developing diverticulitis. However, these people may have few symptoms. |
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Inflammatory bowel disease (such as ulcerative colitis and Crohn disease) |
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Expansion of the large intestine (toxic megacolon) |
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Sometimes spontaneous |
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Injury that occurs during surgical removal of the gallbladder (cholecystectomy) or liver biopsy Rarely, inflammation of the gallbladder (cholecystitis) |
Injury may be to the gallbladder or bile ducts. |
Symptoms
Perforation of the esophagus, stomach, or duodenum causes sudden severe pain, which may travel (radiate) to the shoulder. The person appears very ill, with rapid heart rate, sweating, and an abdomen that is tender and firm to the touch. Because perforation of the small or large intestine often occurs during the course of another painful condition (such as diverticulitis or appendicitis), and because the leaking contents are sometimes contained within a small area in the abdominal cavity without spreading further, symptoms may be less dramatic and can be mistaken for a worsening of the original problem.
In all types of perforation, the person usually has nausea, vomiting, and loss of appetite.
Diagnosis
Treatment
If doctors diagnose a perforation, immediate surgery is usually needed. Doctors decide on which specific operation to do based on the location and cause of the perforation. Doctors' immediate goal is to stop the intestinal contents from spilling into the abdominal or chest cavity. Before surgery, the person receives fluids and antibiotics by vein (intravenously).
Sometimes a small tube is placed through the nose into the stomach to suction out stomach juices so they do not flow out of the perforation and to relieve the pressure (decompress) in the bowel.
