Gastrointestinal perforation

Gastrointestinal perforation is a complete penetration of the wall of the stomach, small intestine or large bowel, resulting in intestinal contents flowing into the abdominal cavity. Perforation of the intestines results in the potential for bacterial contamination of the abdominal cavity (a condition known as peritonitis). Perforation of the stomach can lead to a chemical peritonitis due to leaked gastric acid. Perforation anywhere along the gastrointestinal tract is a surgical emergency.

Causes

Underlying causes include gastric ulcer, appendicitis, gastrointestinal cancer, diverticulitis, Superior Mesenteric Artery Syndrome, trauma, and Ascariasis. In exceptionally rare cases, it can be caused by large objects inserted via the anus, such was the case with the notorious death of Kenneth Pinyan, also known by the name of "Mr. Hands".

Symptoms

Gastrointestinal perforation results in severe abdominal pain intensified by movement, nausea and vomiting. Later symptoms include fever and or chills.

Diagnosis

On X-rays, free gas may be visible in the abdominal cavity. The perforation can often be visualised using CT. White blood cells are often elevated.

Treatment

Treatment depends on the underlying cause. Surgical intervention is nearly always required in form of exploratory laparotomy and closure of perforation with peritoneal wash (Sometimes medical evacuation). Conservative treatment is indicated in case patient is nontoxic and clinicaly stable, these patients are to be treated with IV fluids, antibiotics, nasogastric aspiration and bowel rest.

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