Open Access Articles- Top Results for Gastrointestinal perforation

Gastrointestinal perforation

Gastrointestinal perforation
File:Free air2010.JPG
Free air under the right hemidiaphragm from a bowel perforated.
Classification and external resources
ICD-10 K63.1, S36.9
ICD-9 569.83, 863.9
DiseasesDB 34042
MedlinePlus 000235
eMedicine med/2822
NCI Gastrointestinal perforation
Patient UK Gastrointestinal perforation

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 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.

Signs and symptoms

Sudden attack of pain in epigastrium to the right of midline in case of perforation of duodenal ulcer. In case of gastric ulcer the pain is in epigastrium. There is history of burning pain in epigastrium, flatulence and dyspepsia. History of drug intake without sufficient food intake may be present. In case of intestinal perforation pain starts from the site of perforation, visceral, and then spreads all over the abdomen. In any case there is board-like rigidity of abdomen, tenderness, and rebound tenderness. After some time the abdomen becomes silent, heart sounds can be heard all over. Patient stops passing flatus and motion, abdomen is distended. Gastrointestinal perforation results in severe abdominal pain intensified by movement, nausea, vomiting and hematemesis. Later symptoms include fever and or chills.


Underlying causes include gastric ulcers, duodenal ulcers, appendicitis, gastrointestinal cancer, diverticulitis, Inflammatory Bowel Disease, superior mesenteric artery syndrome, trauma, ascariasis. Typhoid fever, non-steroidal anti-inflammatory drugs, ingestion of corrosives may also be responsible.[citation needed]


On x-rays, free gas/air may be visible in the abdominal cavity. The perforation can often be visualised using computed tomography. White blood cells are often elevated. Visible signs can occasionally include a rigid abdomen on palpation.


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.

External links

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