After a physical exam, your provider may use these tests to look for a gastrointestinal perforation: Blood tests check for signs of infection and assess kidney and liver function. Colonoscopy provides views inside of the colon, or large intestine. X-rays can show air in the abdomen, a sign of a GI tract tear.
Often, patients will not know they have a perforated bowel until symptoms are sever. Early signs of sepsis are: Body temperature above 101 F (38.3 C) or below 96.8 F (36 C) Chills.
In adults, ulcerative disease represents the most common etiology of bowel perforation, with duodenal ulcers causing 2- to 3-times the rate of perforation than gastric ulcers do. Perforation secondary to diverticular disease represents up to 15% of cases.
You can have a hole in your colon that happens by itself. This spontaneous type of perforation is usually due to a medical condition, such as inflammatory bowel disease (IBD). Perforated bowels also can be caused by a medical procedure that's done in or near your digestive tract.
If the hole is in a person's stomach or small intestine, the onset of pain is usually sudden, but if the hole is in the large bowel, the pain may come on gradually. In either case, once the pain starts, it is likely to be constant. The pain may get worse when the person moves or if there is any pressure on the abdomen.
Q. How is colon perforation treated? A: Contained perforation — where the contents of the colon have not leaked into the abdominal cavity because of the tear — can be treated in most cases with percutaneous drainage and intravenous antibiotics. The tear may repair itself once the infection is cleared up.
Survival from the time of perforation differed when compared by BMI groups (p-0.013). Patients with a normal BMI (18.5–25.0 kg/m2) had the longest survival time of 68.0 months, compared to underweight (BMI <18.5 kg/m2) and overweight patients (BMI 25.1–30.0 kg/m2), 14.10, and 13.7 months.
An intestinal perforation is a major life-threatening condition with high morbidity and mortality that requires emergency surgery. Despite improvements in surgical and medical treatments, the overall mortality rate is 30% and the mortality rate of cases that also have diffuse peritonitis is up to 70% [1,2,3,4].
If perforation is suspected then an erect chest X-ray should be performed as well as an abdominal X-ray. This image shows a very large volume of gas under the diaphragm due to bowel perforation.
In addition to the general symptoms of perforation, symptoms of peritonitis may include: fatigue. passing less urine, stools, or gas.
In addition to determining the presence of perforation, CT can also localize the perforation site. The overall accuracy of CT for predicting the site of bowel perforation has been reported to range between 82% and 90% (3, 10, 11).
However, a rare and unusual life-threatening complication of chronic constipation is stercoral perforation. Stercoral perforation is the reported cause of 3·4% of colonic perforations.
The usual length of stay is 5 to 7 days in the hospital. Your doctor may choose to keep you longer if complications arise or if you had a large amount of intestine removed.
Call your doctor if you have abdominal pain that lasts 1 week or longer, if your pain doesn't improve in 24 to 48 hours, if bloating lasts more than 2 days, or if you have diarrhea for more than 5 days.
If excess stool backs up in the intestines, it could put too much pressure on the intestines. This can cause the intestines to perforate or tear. The stool can spill into the abdominal cavity and cause severe and often life-threatening symptoms because stool is acidic and contains bacteria.
Initially, the evaluation of a patient with an intestinal perforation is most commonly performed by the emergency department physician. A thorough history and physical examination can suggest the diagnosis of perforation and help initiate appropriate diagnostic studies and therapeutic modalities.
Exams and Tests
X-rays of the chest or abdomen may show air in the abdominal cavity. This is called free air. It is a sign of a tear. If the esophagus is perforated free air can be seen in the mediastinum (around the heart) and in the chest.
The most common symptom of diverticular disease is intermittent (stop-start) pain in your lower abdomen (stomach), usually in the lower left-hand side. The pain is often worse when you are eating, or shortly afterwards. Passing stools and breaking wind (flatulence) may help relieve the pain.
In most cases of surgery for diverticulitis, a colostomy is not required.
Administer systemic antibiotics (eg, ampicillin, gentamicin, or metronidazole), making a best estimation regarding the likely organisms. Nasogastric suction is required to empty the stomach and reduce the risk of further vomiting. Urinary catheterization is used to assess urinary flow and fluid replacement.
X-rays, a computed tomography (CT) scan (more detailed x-ray), blood tests, or even a diagnostic laparoscopy surgical procedure can be done to diagnose an intestinal injury.
Colonic perforation occurs in 0.03–0.8% of colonoscopies [1, 2] and is the most feared complication with a mortality rate as high as 25% [1]. It may result from mechanical forces against the bowel wall, barotrauma, or as a direct result of therapeutic procedures.