Gastrointestinal Perforation

What is a gastrointestinal perforation?

A gastrointestinal perforation is a hole in your gastrointestinal (GI) tract. Your GI tract is a series of hollow organs that move food and liquids through your body. These organs help digest the things you eat and drink and absorb nutrients. They include your:

• Esophagus: Connects your mouth and stomach.
• Stomach: Digests food.
• Small intestine: Continues digestion and absorbs nutrients.
• Large intestine (bowel or colon): Turns undigested food into stool.

How does a gastrointestinal perforation affect my body?

A perforation in your GI tract requires immediate medical care. A hole in your large intestine, also known as a bowel perforation, can cause stool to leak into your abdomen. A hole in your stomach or small intestine can leak food or digestive fluids into your abdomen. Without prompt treatment, gastrointestinal or bowel perforation can cause:

• Internal bleeding and significant blood loss.
• Peritonitis, inflammation of the inner abdominal wall lining.
• Permanent damage to the GI tract.
• Sepsis, a life-threatening reaction to an infection.

What causes a gastrointestinal perforation?

Injury or trauma can puncture a hole in your GI tract. Possible causes of these injuries include:

• Accidentally swallowing a harmful object or substance: Batteries, corrosive chemicals, magnets or sharp objects can tear the esophagus, stomach or intestines.
• Bowel impaction: A large buildup of stool in the colon that gets stuck.
• A wound from a traumatic event, such as a car accident.
• Forceful vomiting.
• Knife or gunshot wound to the abdomen or torso.
• Medical procedures: Perforation can be a rare complication of surgeries or procedures that affect the GI tract, like colonoscopies.

Certain medical conditions can also cause a gastrointestinal or bowel perforation, including:

• Appendicitis.
• Cancers that affect the digestive system, such as colorectal cancer, esophageal cancer, gastrointestinal stromal tumors or stomach cancer.
• Diverticulitis.
• Hernias.
• Bowel obstruction.
• Gallstones.
• Inflammatory bowel disease (IBD), including Crohn’s disease, ulcerative colitis and microscopic colitis.
• Peptic ulcer disease.

Having one of these conditions doesn’t mean you will have a gastrointestinal perforation, but your risk of having one is higher. That’s why it’s important to know the signs of gastrointestinal perforation and when to seek medical care.

What does a gastrointestinal perforation feel like?

If you have a gastrointestinal or bowel perforation, you may experience:

• Abdominal pain or cramping, which is usually severe.
• Bloating or a swollen abdomen.
• Fever or chills.
• Nausea and vomiting.
• Pain or tenderness when you touch your abdomen.

How is intestinal perforation diagnosed?

Your provider may perform a physical examination and press on your abdomen. They will also take your vital signs, which include:

• Blood pressure.
• Body temperature.
• Pulse and heart rate.
• Respiration (breathing) rate.

Your provider may ask you:

• If you have other health conditions.
• Whether you’ve had any recent medical procedures or surgeries.
• When symptoms started and what they feel like.
• Your family history of cancers, inflammatory bowel disease and other health conditions.

What tests diagnose a gastrointestinal perforation?

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.
• CT scan produces detailed images to help pinpoint where the perforation is.
• Upper endoscopy provides views of the esophagus, stomach and upper part of the small intestine.

How is gastrointestinal perforation treated?

If your provider diagnoses you with a gastrointestinal perforation, you may need emergency surgery to repair it. Depending on the severity and its location, your surgery may include:

• Endoscopic procedure, which uses a camera to guide the instruments through your intestines. This procedure usually doesn’t require incisions.
• Laparoscopic surgery, which uses a camera to see inside the abdomen. You have small incisions with this minimally invasive surgery.
• Traditional open surgery, which requires larger incisions in the abdomen.

In some cases, you may need a temporary bypass for stool so your colon can rest. If you need this procedure, your surgeon:

• Creates a small hole in your abdomen called a stoma.
• Attaches a piece of your small intestine or colon to the stoma.
• Connects a pouch, called a colostomy bag, to the outside of the stoma.

The colostomy bag is a sealed, discreet pouch that collects stool. You or your caregiver empties the bag each day. Your provider usually removes the stoma and colostomy bag after you’ve healed.

Can a perforated bowel heal itself?

Small gastrointestinal or bowel perforations can sometimes heal without surgery. However, you can’t know this until you have a diagnosis, so seek medical care right away. You usually need intravenous (given through a vein) antibiotics and close monitoring.

Gastrointestinal perforations can be fatal. Do not try to care for this condition at home. Always seek immediate medical care if you think you have a gastrointestinal perforation.

What medications do I need for gastrointestinal perforation?

Most people receive antibiotics, either with or without surgery, to treat gastrointestinal perforation. These medications help prevent infections that can occur from perforation. You may have to take these medications for several weeks. Take the full course of medicine, and don’t stop taking your antibiotics unless your provider tells you to do so.

How can I reduce my risk of a gastrointestinal perforation?

You might not be able to prevent gastrointestinal perforation altogether. But you can decrease your risk if you:

• Don’t smoke or use tobacco products.
• Eat a healthy diet with enough fiber, which can prevent constipation and keep your digestion running smoothly.
• See your provider regularly to manage health conditions and report any new symptoms, including digestive problems or pain.

What is the outlook for gastrointestinal perforation?

A full recovery after gastrointestinal perforation surgery can take several weeks. Many people who have successful treatment recover completely. See your provider for follow-up care.

Can you get gastrointestinal perforation more than once?

It’s possible to have a gastrointestinal perforation more than once, but this is uncommon. See your provider regularly to manage health conditions and help lower your risk of a future perforation.

When should I seek care for gastrointestinal perforation?

Because a gastrointestinal perforation can be life-threatening, seek emergency care if you notice any of its symptoms. Don’t wait to see if it goes away on its own.

A note from Cleveland Clinic

Gastrointestinal perforation is a serious condition that requires immediate medical care. However, with today’s surgical techniques and medications, many people make a full recovery. It’s important to know the signs of a gastrointestinal perforation and your risk factors. With this knowledge, you can take an active role in your health and improve your chances of successful treatment.