Small Bowel Perforation
Gastrointestinal perforation is a hole that develops through the walls of the GI tract. Any part of the GI tract can be perforated starting from the wall of the esophagus, the stomach, small intestine, large bowel, rectum or the gall bladder. The gastric or intestinal contents released spill into the peritoneal space. Peritonitis or inflammation of the membrane lining the abdominal cavity is caused due to GI tract perforation. The onset of gastrointestinal perforation is always sudden and is deemed as a medical emergency.
- Inflammatory bowel disease like ulcerative colitis and Crohn’s diease
- Gastrointestinal cancer
- Superior mesenteric artery syndrome
- Diverticulitis
- Appendicitis
- Gastric ulcer
- Peptic ulcer disease
- Blunt trauma to the stomach
- Knife and stab wounds to the stomach
- Intake of non-steroidal anti-inflammatory drugs, steroids and aspirin
- Cancer treatment drugs such as bevacizumab
- Bowel injuries due to endoscopy or colonoscopy
- Severe abdominal pain
- Chills
- Fever
- Nausea
- Vomiting
- Heavy to medium rectal bleeding
- Symptoms of peritonitis such as exhaustion, shortness of breath, rapid heartbeat and passing less urine, stools and gas
Abdominal series: Supine and upright x-rays of the chest and abdomen are ordered to check for air in the abdominal cavity. Free air is shown under the diaphragm in the abdominal cavity if there is a hole in the intestine. Lateral chest x-rays are more effective in detecting free air than posteroanterior x-rays.
CT scan: The computed tomography shows the exact location of the hole in the intestine. This is usually done when the abdominal series is non-conclusive. An abdominal CT scan with IV and rectal contrast may be done. Barium is usually not done if a perforation of the intestine is suspected.
WBC :A white blood cell count is taken to assess elevation of white blood cells, indicating infection and inflammation.
Treatment is surgical. Bowel perforation is a surgical emergency. If not operated on time the patient may go into severe sepsis and multi-organ failure.