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Intestinal perforation

Gastrointestinal perforation
Synonyms Ruptured bowel, gastrointestinal rupture
Free air2010.JPG
Free air under the right diaphragm from a perforated bowel.
Specialty Gastroenterology, emergency medicine
Symptoms Abdominal pain, tenderness
Complications Sepsis, abscess
Usual onset Sudden or more gradual
Causes Trauma, following colonoscopy, bowel obstruction, colon cancer, diverticulitis, stomach ulcers, ischemic bowel, C. difficile infection
Diagnostic method CT scan, plain X-ray
Treatment Emergency surgery in the form of an exploratory laparotomy
Medication Intravenous fluids, antibiotics
Prognosis Risk of death up to 50%
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Gastrointestinal perforation, also known as ruptured bowel, is a hole in the wall of part of the gastrointestinal tract. The gastrointestinal tract includes the esophagus, stomach, small intestine, and large intestine. Symptoms include severe abdominal pain and tenderness. When the hole is in the stomach or early part of the small intestine the onset of pain is typically sudden while with a hole in the large intestine onset may be more gradual. The pain is usually constant in nature.Sepsis, with an increased heart rate, increased breathing rate, fever, and confusion may occur.

The cause can include trauma such as from a knife wound, eating a sharp object, or a medical procedure such as colonoscopy, bowel obstruction such as from a volvulus, colon cancer, or diverticulitis, stomach ulcers, ischemic bowel, and a number of infections including C. difficile. A hole allows intestinal contents to enter the abdominal cavity. The entry of bacteria results in a condition known as peritonitis or in the formation of an abscess. A hole in the stomach can also lead to a chemical peritonitis due to gastric acid. A CT scan is typically the preferred method of diagnosis; however, free air from a perforation can often be seen on plain X-ray.


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