General

Intestinal perforation: causes, symptoms, treatment

The term “gastro-intestinal perforation” consists of an open hole that extends full-length across the inside of an empty digestive organ and connects the interior in the visceral lumen the peritoneal cavity or an adjacent organ. This can trigger extreme pain that is sudden and intense in the abdomen or chest region.

In the event of perforation food, gastric juices, and all that is inside the part that is gastrointestinal tract that is affected could be poured through the stomach (or occasionally when it is the case of perforations in the esophageal duct or in the chest) with potentially grave consequences. If there is no evidence of prompt intervention there is a chance that the septic state (a critical condition that causes acute circulatory dysfunction caused by an infection that is widespread that is present in blood) that can have fatal consequences is detected.

Thus, a prompt diagnosis is crucial, and typically involves instrumental tests such as computed tomography or radiographs which allows for quick and effective surgical treatments for the problem.

  1. Causes

From a broad point of an overall perspective, the probable reasons for injury and perforation may be of 4 distinct kinds:

 

Ischemia, i.e. disruption the flow of blood oxygenated to the organ as a result of necrosis or obstruction of the intestinal tract.

Infection, such as in the cases of appendicitis or diverticulitis.

Erosion, for example, from tumors or ulcers

Physical injury from trauma (e.g. shooting wound) or an iatrogenic injury (e.g. caused by endoscopic examinations)

For more in-depth analysis, looking at the various organs and tracts that comprise the digestive system an esophagus perforation could typically be caused by:

Boerhaave’s syndromeis a condition which is caused by an abrupt ruptures of the esophagus that is typically caused by or facilitated by vomiting that is incoercible (as is the case with bulimic patients) which cause an abrupt rise in pressure inside the esophageal canal.

Iatrogenic injury: certain medical procedures, for instance ones that require the introduction of an esophagoscope, or the use of balloons and dilator probes could result in perforation of an organs;

Consumption of corrosive substances, particularly strong acids or alkalis.

Duodenum and stomach (first section of the small intestinal tract) may perforate

In the case of Peptic ulcers (not necessarily symptoms-related) that have caused an inflammation of the mucosa that lines the organs, and a degeneration of the tissue because of the damaging action of gastric acids as well as digestive juices.

in the event of ingestion of particular corrosive substances (in this instance, the stomach is affected to greater degree that it is the duodenum);

The small intestine could be perforated with:

 

obstructions of a blood vessel nature which hinders blood flow into the tissue , resulting in necrosis of the cells (death) (as happens in the event of ischemia due to ischmic colitis);

complications of morbid conditions like appendicitis or Meckel’s diverticulum (sac-like exroversion into the wall in the small intestine that is present since the time of birth);

Infectious processes that affect the intestinal tract (such such as for instance typhoid disease);

The large colon (especially the colon) may be perforated:

when obstructions (fecalomas or tumor processes, foreign body parts) are in the body;

If the patient is suffering from chronic inflammatory bowel disorder (such like Crohn’s or ulcerative rectocolitis);

caused by due to diverticulitis (inflammation and infection the intestinal diverticula in which perforation is a complication that affects around 1015 percent in patients);

when there is toxic megacolon (dreaded condition that is a complication of ulcerative Rectocolitis that is characterized by an abnormal distension within the large intestine);

in the course of colonoscopy

Rarely, spontaneously.

The gallbladder, as well as the bile ducts, could be perforated during the course of a cholecystectomy biopsy, and, in rare instances in the course of an inflammation (cholecystitis).

In addition, any part that is located in the digestive tract can become affected due to trauma or the entry of a foreign object capable to cause parietal lesions (obstructions and perforations) through mechanically inserting or blocking it in the viscera it is passing through (especially in the rectum and colon).

In young children, intestinal perforation is typically the result of an abdominal injury.

  1. Symptoms

The signs and symptoms of a gastrointestinal perforation vary and are closely dependent on the area at which the perforation takes place and also on how healthy the individual is.

Typically, the perforation in the stomach, stomach, and esophagus duodenum is sudden and can result in an abdominal pain generalized that may radiate into the shoulder. It can also can be accompanied by

  • Nausea and vomiting
  • Anorexia (absolute inability to eat)
  • More sweating
  • An increase in heart rate (tachycardia)
  • Chills
  • Abdomen that is untreatable (rigid to the point and painful)

The peristalsis of the stomach (contraction of the smooth muscle in the gastrointestinal tract visible on auscultation in the shape of abdominal noises produced by the gas found in the intestinal tract) insufficient or unnoticeable it is it is a sign of irritation in the peritoneum (membrane which connects the organs that are contained within the abdomen cavity).

In some instances the gastrointestinal perforation can occur within the context of an underlying inflammation (e.g. diverticulitis, gastrointestinal perforation and chronic inflammatory bowel diseases) and, as such, the pain is usually more gradual and less acute. It can also develop slowly which makes timely diagnosis difficult.

In this way one can discern the focal pattern of discomfort (referred to a particular abdomen quadrant):

Pain that is present in the upper-central area of the abdomen. This could be due to an open stomach-duodenal ulcer;

The lower part of the abdomen, which could be an indication of appendicitis perforated (in younger patients) or rupture of the diverticular ligament (in the elderly).

  1. Complications

The general health condition of the person suffering from perforation is the most reliable indicator of prognosis. That is, of a possible development of the condition. The most common complications of a gastrointestinal apex are:

Hypovolemic Shock: A condition that results from sudden decreases in the circulating blood mass caused by hemorrhage or loss of fluid (hypovolemia);

Septicemia: a syndrome resulting from the abnormal systemic inflammatory response set in by the body by due to the passage of pathogenic microorganisms into the blood (as occurs in the case of digestive perforation that involves the passage of bacteria that are present inside the intestinal microflora in abdomen cavity).

  1. Diagnosis

The diagnosis is made, on top of the gathering details of the medical history as well as symptoms, on investigation performed by some instruments that aim to reveal the presence of air bubbles within the abdominal cavity as an indication of perforation

Radiographs of the abdomen and chest (allow to see the most of the time the presence of breath from the digestive tract);

The abdomen is scanned by computed tomography (more often, for confirmatory measure, it’s beneficial to determine the exact location and the severity of perforations, taking into consideration the possibility of passing of contrast fluid into the perforation).

  1. Care

If there is a digestive perforation, it is essential to act quickly initially through an administration of fluids (necessary to treat low blood volume and get blood pressure within normal ranges) as well as intravenously administered antibiotics (to decrease the burden of bacterial infections) If there is no evidence of perforation and there is no indication for a possible infection, such as when an unintentionally contained perforation the option of waiting in a state of watchful anticipation and non-surgical treatment with antibiotics may be considered in collaboration by the surgeons.

In the majority of cases, it is essential to intervene in stopping the release of the contents of the intestinal tract to the abdominal cavity or thoracic cavity through surgery that aims to close the perforation. It usually involves an open examination (through an incision that is traditional) or via laparoscopic method using a minimally-invasive method of repair and exploration which is often adequate.

A naso-gastric tube can be placed, in some situations, to facilitate an intestinal decompression, by sucking in gastric juices as well as other kinds of substances that may be leaking into the perforation.

 

 

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