All you wanted to know about Gastrointestinal Perforation

Dr. Manish Joshi is a Consultant Surgical Gastroenterologist, GI Oncologist and Advanced Laparoscopic Surgeon at the BGS Global Hospitals, Bangalore. He had earlier served as Head of Surgical Gastroenterology services at St. John’s Medical College Hospital, Bangalore for almost 3 years. 

What is Gastrointestinal Perforation?

Gastrointestinal perforation (GP) occurs when a hole forms all the way through the stomach, large bowel, or small intestine. It can be due to a number of different diseases, includingappendicitisanddiverticulitis. It can also be the result of trauma, such as a knife wound or gunshot wound. A perforation may also occur in the gallbladder. This can have symptoms that are similar to the symptoms of a gastrointestinal perforation.  A hole in your gastrointestinal system or gallbladder can lead to peritonitis.Peritonitisis inflammation of the membrane that lines the abdominal cavity. GP is a medical emergency that requires immediate medical care. The condition is life-threatening. Chances of recovery improve with early diagnosis and treatment. This condition is also known as intestinal perforation or perforation of the intestines. 

 

Causes of Gastrointestinal Perforation?

Illnesses can cause GP, including: 

  • appendicitis, which is more common among older persons 
  • diverticulitis, which is a digestive disease 
  • astomach ulcer 
  • gallstones 
  • gallbladder infection 
  • inflammatory bowel diseasessuch asCrohn’s diseaseorulcerative colitis, which is less common 
  • inflamedMeckel’s diverticulum, which is a congenital abnormality of the small intestine that’s similar to the appendix 
  • cancer in the gastrointestinal tract 

The condition may also be due to: 

  • blunt trauma to the abdomen 
  • a knife or gunshot wound to the abdomen 
  • abdominal surgery 
  • stomach ulcers due to taking aspirin, nonsteroidalanti-inflammatory drugs, and steroids (more common in older adults) 
  • ingestion offoreign objectsor caustic substances 

Smokingand excessive use ofalcoholincrease your risk of GP. Rarely, the condition may occur due to bowel injuries from anendoscopyorcolonoscopy. 

Symptoms of Gastrointestinal Perforation

Severe Stomach Pain

Chills

a

Fever

Nausea

Vomiting

When you’ve had a gastrointestinal perforation and peritonitis occurs, the abdomen feels very tender. Pain often worsens when someone touches or palpates the area or when the patient moves. Pain is generally better when lying still. The abdomen maystick outward fartherthan normal and feel hard.  In addition to the general symptoms of perforation, symptoms of peritonitis may include:

Fatigue

Passing less urine, stools, or gas

Shortness of Breath

A fast heartbeat

Dizziness

Complications associated with gastrointestinal perforation?

Complications associated with GP include: 

  • Bleeding
  • sepsis, which is a life-threatening bacterial infection
  • abscesses in the belly
  • a wound infection
  • a bowel infarction, which is the death of part of the bowel
  • a permanent ileostomy or colostomy 

Wound failure may occur in some cases. “Wound failure” means the wound can’t or doesn’t heal. Factors that increase the risk of this include: 

  • malnutrition, or poor diet
  • smoking
  • excessive alcohol use
  • drug abuse
  • poor hygiene
  • sepsis
  • uremia, which is an illness caused by kidney failure
  • obesity
  • hematoma, which occurs when blood collects outside the blood vessels
  • type 2 diabetes
  • steroid therapy or the use of corticosteroids, which are anti-inflammatory drugs that suppress the immune system and can mask an ongoing infection and delay diagnosis
  • the use of biologic agents for conditions such as Crohn’s disease, ulcerative colitis, rheumatoid arthritis 

How is Gastrointestinal Perforation Diagnosed?

To diagnose GP, your doctor will likely takeX-rays of your chestorabdomento check for air in the abdominal cavity. They may also perform aCT scan to get a better idea where the perforation might be. They’ll also order lab work to: 

  • look for signs of infection, such as a highwhite blood cell count 
  • evaluate your hemoglobin level, which can indicate if you have blood loss 
  • evaluateelectrolytes 
  • evaluate acid level in the blood 
  • assesskidney function 
  • assessliver function 

What are the treatment options for Gastrointestinal Perforation?

In most cases, surgery is necessary to close the hole and treat the condition. The goals of the surgery are to: 

  • fix the anatomical problem 
  • fix the cause of peritonitis 
  • remove any foreign material in the abdominal cavity that might cause problems, such as feces, bile, and food 

In rare cases, your doctor may forgo surgery and prescribe antibiotics alone if the hole closed on its own. 

Sometimes, a piece of the intestine will need removal. The removal of a portion of either the small or large intestine may result in acolostomyorileostomy, which allows intestinal contents to drain or empty into a bag attached to your abdominal wall. 

Gastrointestinal Perforation FAQ's

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Ask the Doctor

PreOp-Instructions

  • ON THE DAY BEFORE SURGERY
    Proceed with normal activities, normal diet & Shower
  • AFTER MIDNIGHT BEFORE THE DAY OF SURGERY
    Do not eat or drink anything, including water, candy, gum, mints, Brushing teeth is okay
  • ON THE DAY OF SURGERY
    Do not eat or drink anything Brushing teeth is okay Shower if you did not shower the night before
  • These are typical instructions. Your instructions by your surgeon or doctor may vary.

These are typical instructions. Your instructions by your surgeon or doctor may vary.

PostOp-Instructions

  • ON THE DAY BEFORE SURGERY
    Proceed with normal activities, normal diet & Shower
  • AFTER MIDNIGHT BEFORE THE DAY OF SURGERY
    Do not eat or drink anything, including water, candy, gum, mints, Brushing teeth is okay
  • ON THE DAY OF SURGERY
    Do not eat or drink anything Brushing teeth is okay Shower if you did not shower the night before
  • These are typical instructions. Your instructions by your surgeon or doctor may vary.

These are typical instructions. Your instructions by your surgeon or doctor may vary.

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Dr. Manish Joshi is the Best Gastrointestinal surgeon in Bangalore & India. He is an expert in Advanced Laparoscopic & Robotic Surgical Techniques. His motto is ‘Patient comes first” View Profile.

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