Gastrointestinal perforation

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Gastrointestinal perforation
Free air2010.JPG
Free air under the right hemidiaphragm from a bowel perforated.
Classification and external resources
Specialty gastroenterology, emergency medicine
ICD-10 K63.1, S36.9
ICD-9-CM 569.83, 863.9
DiseasesDB 34042
MedlinePlus 000235
eMedicine med/2822

Gastrointestinal perforation is a complete penetration of any part of the wall of the gastrointestinal tract, which lines the stomach, small intestine or large bowel, resulting in intestinal contents entering 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.

Gastrointestinal perforation rarely results in sudden death.[1]

Signs and symptoms[edit]

Sudden pain in the epigastrium to the right of the midline indicates perforation of a duodenal ulcer. In a gastric ulcer perforation creates a history of burning pain in epigastrium, with flatulence and dyspepsia. A history of drug intake with insufficient food intake may be present.

In intestinal perforation pain starts from the site of perforation and spreads across the abdomen.

Gastrointestinal perforation results in severe abdominal pain intensified by movement, nausea, vomiting and hematemesis. Later symptoms include fever and or chills.[2]

In any case, the abdomen becomes rigid with tenderness and rebound tenderness. After some time the abdomen becomes silent and heart sounds can be heard all over. Patient stops passing flatus and motion, abdomen is distended.

Causes[edit]

Underlying causes include gastric ulcers, duodenal ulcers, appendicitis, gastrointestinal cancer, diverticulitis, inflammatory bowel disease, superior mesenteric artery syndrome, trauma and ascariasis. Typhoid fever,[3] non-steroidal anti-inflammatory drugs,[4][5] ingestion of corrosives may also be responsible.[6]

Diagnosis[edit]

On x-rays, gas may be visible in the abdominal cavity. Gas is easily visualized on x-ray while the patient is in an upright position. The perforation can often be visualised using computed tomography. White blood cells are often elevated.

Treatment[edit]

Treatment depends on the underlying cause. Surgical intervention is nearly always required in form of exploratory laparotomy and closure of perforation with peritoneal wash. Conservative treatment including intravenous fluids, antibiotics, nasogastric aspiration and bowel rest is indicated if the patient is nontoxic and clinically stable. Consultation with a specialist is often needed.

References[edit]

  1. ^ Murty OP, Fan LY, Siang TL, binti Hasbullah NE, binti Mohd Ismail NE (2007). "Fatal Gastrointestinal Perforations in sudden death cases in Last 10 years at UMMC – Malaysia". Internet Journal of Medical Update 2 (1): 31–36. doi:10.4314/ijmu.v2i1.39845. 
  2. ^ Ansari, Parswa. "Acute Perforation". Merck Manuals. Retrieved June 30, 2016. 
  3. ^ Sharma AK, Sharma RK, Sharma SK, Sharma A, Soni D (2013). "Typhoid Intestinal Perforation: 24 Perforations in One Patient". Ann Med Health Sci Res. 3 (Suppl1): S41–S43. doi:10.4103/2141-9248.121220. PMC 3853607. 
  4. ^ R I Russell (2001). "Non-steroidal anti-inflammatory drugs and gastrointestinal damage—problems and solutions". Postgrad Med J 77 (904): 82–88. doi:10.1136/pmj.77.904.82. 
  5. ^ Carlos Sostres; Carla J Gargallo; Angel Lanas (2013). "Nonsteroidal anti-inflammatory drugs and upper and lower gastrointestinal mucosal damage". Arthritis Res Ther. 15 (Suppl 3): S3. doi:10.1186/ar4175. PMC 3890944. 
  6. ^ Ramasamy, Kovil; Gumaste, Vivek V. (2003). "Corrosive Ingestion in Adults". Journal of Clinical Gastroenterology: 37 (2): 119–124. 

External links[edit]