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Perforation of the Digestive Tract


Parswa Ansari

, MD, Hofstra Northwell-Lenox Hill Hospital, New York

Last full review/revision Apr 2020| Content last modified Apr 2020
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Any of the hollow digestive organs may become perforated (punctured), which causes a release of gastrointestinal contents and can lead to sepsis Sepsis and Septic Shock Sepsis is a serious bodywide response to bacteremia or another infection plus malfunction or failure of an essential system in the body. Septic shock is life-threatening low blood pressure ... read more (a life-threatening infection of the bloodstream) and death if surgery is not done immediately.

  • Symptoms include sudden severe pain in the chest or abdomen and an abdomen that is tender when touched.

  • X-rays or computed tomography is used to make the diagnosis.

  • Immediate surgery is needed.

A perforation allows food, digestive juices, or other intestinal contents to leak into the abdomen (or sometimes the chest, if the esophagus is perforated). These materials are very irritating and contain bacteria, which cause severe inflammation and infection that are typically fatal if untreated.

Causes of a Perforated Digestive Tract

Symptoms of a Perforated Digestive Tract

Perforation of the esophagus, stomach, or duodenum causes sudden severe pain, which may travel (radiate) to the shoulder. The person appears very ill, with rapid heart rate, sweating, and an abdomen that is tender and firm to the touch. Because perforation of the small or large intestine often occurs during the course of another painful condition (such as diverticulitis Diverticulitis Diverticulitis is inflammation of one or more balloon-like sacs (diverticula). Infection may or may not develop. Diverticulitis usually affects the large intestine (colon). Left lower abdominal... read more Diverticulitis or appendicitis Appendicitis Appendicitis is inflammation and infection of the appendix. Often a blockage inside the appendix causes the appendix to become inflamed and infected. Abdominal pain, nausea, and fever are common... read more ), and because the leaking contents are sometimes contained within a small area in the abdominal cavity without spreading further, symptoms may be less dramatic and can be mistaken for a worsening of the original problem.

In all types of perforation, the person usually has nausea, vomiting, and loss of appetite.

Diagnosis of a Perforated Digestive Tract

Treatment of a Perforated Digestive Tract

  • Surgery

  • Fluids and antibiotics by vein

If doctors diagnose a perforation, immediate surgery is usually needed. Doctors decide on which specific operation to do based on the location and cause of the perforation. Doctors' immediate goal is to stop the intestinal contents from spilling into the abdominal or chest cavity. Before surgery, the person receives fluids and antibiotics by vein (intravenously).

Sometimes a small tube is placed through the nose into the stomach to suction out stomach juices so they do not flow out of the perforation and to relieve the pressure (decompress) in the bowel.

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