Symptoms include sudden severe pain in the chest or abdomen and an abdomen that is tender when touched.
X-rays or computed tomography is used to make the diagnosis.
Immediate surgery is needed.
(See also Overview of Gastrointestinal Emergencies Overview of Gastrointestinal Emergencies Certain gastrointestinal disorders can be life threatening and require emergency treatment. For many people, emergency treatment involves surgery. Abdominal pain, often severe, usually accompanies... read more .)
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 of a Perforated Digestive Tract
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 Foreign Bodies in the Digestive Tract Foreign bodies are ingested objects that can get stuck in the digestive tract and sometimes perforate (pierce) it. Foreign bodies may be accidentally or intentionally swallowed. Foreign bodies... read more usually pass through a person without difficulty but occasionally become stuck and lead to perforation. Foreign bodies inserted through the anus Foreign Objects in the Rectum Foreign objects in the rectum are usually objects that have been inserted into the rectum but also may have been swallowed. Objects that have been inserted into the rectum intentionally or swallowed... read more may perforate the rectum or colon.
Symptoms of a Perforated Digestive Tract
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 Diverticulitis Diverticulitis is inflammation of one or more balloon-like sacs (diverticula). Infection may or may not develop. Diverticulitis usually affects the large intestine (colon). Left lower abdominal... read more or appendicitis Appendicitis Appendicitis is inflammation and infection of the appendix. Often a blockage inside the appendix causes the appendix to become inflamed and infected. Abdominal pain, nausea, and fever are common... read more ), 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 of a Perforated Digestive Tract
X-rays of the chest and abdomen
Sometimes computed tomography (CT)
The doctor usually takes x-rays X-Ray Studies of the Digestive Tract X-rays often are used to evaluate digestive problems. Standard x-rays (plain x-rays) do not require any special preparation (see Plain X-Rays). These x-rays usually can show a blockage or paralysis... read more of the chest and abdomen, which may show air that has leaked from the digestive system, a sure sign of perforation. Sometimes, the doctor needs to do a CT Computed Tomography and Magnetic Resonance Imaging of the Digestive Tract Computed tomography (CT—see also Computed Tomography (CT)) and magnetic resonance imaging (MRI—see also Magnetic Resonance Imaging (MRI)) scans are good tools for assessing the size and location... read more scan of the abdomen to confirm the diagnosis.
Treatment of a Perforated Digestive Tract
Fluids and antibiotics by vein
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.