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Bowel perforation is an acute abdominal condition in which the intestine is perforated. Depending on the location of the tear, bowel perforation can cause a variety of symptoms. Bowel perforation is a condition that requires prompt diagnosis and treatment. If left untreated, perforation of the intestine can cause serious intra-abdominal infection. Find out the most common causes of bowel perforation, what is the diagnosis of bowel perforation, and how to treat bowel perforation.

Intestinal perforationis a medical term forperforationof that organ. In the case of intestinal perforation, the continuity of its wall is broken. This creates an opening that allows the contents of the intestine to escape into the abdominal cavity. Bowel perforation is an emergency and requires urgent treatment.Bowel perforation belongs to the group of conditions known as "acute abdomen" . This term refers to sudden, serious diseases of the abdominal cavity, which most often require urgent surgery.

In a he althy body, the digestive tract is a continuous structure. From the esophagus, through the stomach and small intestine to the large intestine, the walls of the digestive tract must be fully sealed. Thanks to this, the contents of the digestive tract - food debris, digestive juices and numerous bacteria do not spread throughout the abdominal cavity.

The intestine is a large organ, on average between 5 and 7 meters in length.Perforation can occur in any part of the bowel . The location of the perforation is of great clinical importance. Depending on the site of the perforation, the patient may have different clinical signs. Additionally, perforation of different sections of the intestine carries different complications.

Intestinal perforation - causes

A perforation in the intestine can have many causes. Some diseases leading to perforation may cover the entire length of the intestine, while others affect specific sections of the intestine. It is also worth knowing that in some cases of intestinal perforation, it is not possible to identify the factor that caused it. This perforation of the intestine is called idiopathic or idiopathic.

Bowel perforation is usually associated with a malfunction of the intestinal wall. One of the conditionsproper functioning of the intestinal wall is their proper blood supply.

Pressure on the intestinal wall (caused by e.g. fecal calculus or a tumor developing in the intestinal lumen) leads to a local reduction in blood flow.

The ischemic wall of the intestine undergoes rapid necrosis leading to perforation . A similar effect is caused by blocking the blood flow in the vessels supplying blood to the intestines (known as acute intestinal ischemia).

Another commoncause of intestinal perforation is intestinal inflammation . Both acute intestinal inflammation:

  • acute appendicitis,
  • severe Clostridium difficile infection,

and exacerbations of chronic diseases:

  • Crohn's disease,
  • ulcerative colitis can be complicated by intestinal perforation.

In the case of the large intestine, diverticulitis is a very common cause of perforation .

The causes of perforation of the initial section of the intestine - the duodenum - are different from that of the rest of the intestine.Perforation within the duodenum is the most common complication of peptic ulcer disease .

The duodenum is the most common (approx. 60%) location of peptic ulcers. Very deep ulcers can cover the full thickness of the duodenal wall, eventually leading to a perforation.

The possible causes of intestinal perforation includeinjuries . The most common cause of traumatic perforation of the intestine is trauma to the abdominal cavity with a sharp instrument. This type of bowel perforation can also be a complication of surgery (accidental damage to the intestine during abdominal surgery). This type of intestinal perforation is called iatrogenic, i.e. treatment-related.

Causes of intestinal perforation in children

The causes of intestinal perforation discussed so far concerned mainly adults. However,bowel perforation can also occur in children , including infants. In this youngest population, intestinal perforation is most often associated with a specific medical condition, necrotizing enterocolitis. It is a disease that is only recognized in newborns.

Necrotising enterocolitis occurs most often in premature babies, newborns with severe infections or birth defects. Intestinal perforation in the course of this condition may require surgery in the first days of a child's life.

Bowel perforation - symptoms

The first symptom of bowel perforation is sudden, severe pain in the abdomen. Initially, the pain is well-located and responsivethe place where the perforation occurred. Further symptoms of perforation result from the leakage of the intestinal contents into the abdominal cavity.

The digestive tract is naturally filled with gas. When the intestine is perforated, there is abdominal distension due to gas being displaced into voids. Along with the gas, digestive juices, food debris and bacteria colonizing the digestive tract move outside the intestines. The presence of these substances in the abdominal cavity causes a lot of damage, eventually leading to peritonitis.

Depending on the location of the perforation, peritonitis may be slightly different. In the case of duodenal perforation, bile enters the peritoneum primarily, causing chemical peritonitis.

In turn, when the large intestine is perforated, a huge amount of bacteria enters the peritoneum. The large intestine is the part of the digestive tract where most bacteria are located.

Perforation at this point may rapidly develop septic shock. The developing peritonitis causes further symptoms of bowel perforation. The so-called peritoneal symptoms - including increased abdominal muscle tension and severe pain during the examination.

Paralytic intestinal obstruction develops gradually, leading to the disappearance of peristalsis and the retention of gas and stool.

The development of an infection in the abdominal cavity causes general symptoms - fever, increased heart rate, significant weakness. If the infection is not stopped in time, it can be life-threatening.

Intestinal perforation - diagnosis

If intestinal perforation is suspected, the first is a physical examination of the abdominal cavity. Intestinal perforation is manifested by abdominal distension and severe pain. As peritonitis develops, the so-called peritoneal symptoms. The perforation of the intestine leads to the inhibition of intestinal peristalsis.

When auscultation of the abdominal cavity with a stethoscope, no sounds are heard. Imaging tests should be performed to confirm the diagnosis of bowel perforation. The most basic of these is the abdominal X-ray (X-ray).

A typical symptom of perforation is the presence of free air in the abdominal cavity. If the photo is taken in an upright position, air collects below the diaphragm. In some patients, the x-ray is taken in the position on the left side. Then the abdominal organs move downwards and air is visible in the upper part.

When traditional methods are not enough formore accurate imaging studies may be necessary. Usually, a CT scan of the abdomen is performed first. This test allows you to accurately visualize even a small amount of free air or fluid in the abdominal cavity.

Historically, contrasting radiographs were taken to confirm intestinal perforation. After administering the contrast to the gastrointestinal lumen, leakage of the contrast through the opening in the intestinal wall was observed. Currently, such tests are only performed in doubtful cases.

Bowel perforation is a medical emergency that can result in a sharp deterioration in the function of all organs. Peritonitis in the course of intestinal perforation may lead to the development of septic shock.

For this reason, patients with intestinal perforation require a lot of additional laboratory tests:

  • electrolytes,
  • white blood cell count,
  • kidney parameters
  • and hepatic),

ratings of inflammatory indicators:

  • OB,
  • CRP),

and vital functions monitoring.

Intestinal perforation - treatment

Intestinal perforation is a condition that absolutely requires surgical treatment. Untreated intestinal perforation leads to widespread infection of the abdominal cavity and can be life-threatening. For this reason, a patient diagnosed with intestinal perforation is immediately prepared for surgery.

In case of intestinal perforation, food consumption should be withheld - the patient must be nourished and hydrated parenterally (intravenously). In order to stop the spread of infection, intensive antibiotic therapy is necessary (usually at least 2 antibiotics administered intravenously).

The mainstay of treating intestinal perforation is surgery. In most cases, an opening in the abdomen (laparotomy) is performed. After locating the perforation site, it is necessary to remove the damaged part of the intestine and then fuse both ends.

In cases of extensive inflammation, immediate fusion may not be possible. Then a temporary stoma emerges (leading the intestine outside the skin), and the anastomosis is performed after the tissues have healed properly.

In some cases of perforation, the procedure is performed using the laparoscopic method (through small incisions in the abdominal walls and inserting the camera inside with instruments). This method is used, inter alia, in the case of duodenal perforation.

If the perforation has occurred further in the intestine, it is usually necessary to open the abdominal cavity. During the operation, the surgeon performs thealso rinsing the peritoneal cavity with an antiseptic solution. In this way, bacteria and impurities that have entered the abdominal cavity from the inside of the intestine are removed, which significantly reduces the spread of infection.

  • Intestinal obstruction - symptoms, causes and treatment
  • Intestinal diseases
  • Intestines - what do you need to know about them?

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Category:

Gastrology