Gastrointestinal perforation

Gastrointestinal perforation
Other names	Ruptured bowel,[1] gastrointestinal rupture
Free air under the right diaphragm from a perforated bowel.
Specialty	Gastroenterology, emergency medicine
Symptoms	Abdominal pain, tenderness[2]
Complications	Sepsis, abscess[2]
Usual onset	Sudden or more gradual[2]
Causes	Trauma, following colonoscopy, bowel obstruction, colon cancer, diverticulitis, stomach ulcers, ischemic bowel, C. difficile infection[2]
Diagnostic method	CT scan, plain X-ray[2]
Treatment	Emergency surgery in the form of an exploratory laparotomy[2]
Medication	Intravenous fluids, antibiotics[2]

Gastrointestinal perforation, also known as gastrointestinal rupture,^[1] is a hole in the wall of the gastrointestinal tract. The gastrointestinal tract is composed of hollow digestive organs leading from the mouth to the anus.^[3] Symptoms of gastrointestinal perforation commonly include severe abdominal pain, nausea, and vomiting.^[2] Complications include a painful inflammation of the inner lining of the abdominal wall and sepsis.

Perforation may be caused by trauma, bowel obstruction, diverticulitis, stomach ulcers, cancer, or infection.^[2] A CT scan is the preferred method of diagnosis; however, free air from a perforation can often be seen on plain X-ray.^[2]

Perforation anywhere along the gastrointestinal tract typically requires emergency surgery in the form of an exploratory laparotomy.^[2] This is usually carried out along with intravenous fluids and antibiotics.^[2] Occasionally the hole can be sewn closed while other times a bowel resection is required.^[2] Even with maximum treatment the risk of death can be as high as 50%.^[2] A hole from a stomach ulcer occurs in about 1 per 10,000 people per year, while one from diverticulitis occurs in about 0.4 per 10,000 people per year.^[1][4]