Gastrointestinal perforation is a complete penetration of the wall of the stomach, small intestine or large bowel, resulting in intestinal contents flowing into the abdominal cavity. Perforation of the intestines results in the potential for bacterial contamination of the abdominal cavity (a condition known as peritonitis

Peritonitis

Peritonitis is an inflammation of the peritoneum, the serous membrane that lines part of the abdominal cavity and viscera. Peritonitis may be localised or generalised, and may result from infection or from a non-infectious process.-Abdominal pain and tenderness:The main manifestations of...

). Perforation of the stomach

Stomach

The stomach is a muscular, hollow, dilated part of the alimentary canal which functions as an important organ of the digestive tract in some animals, including vertebrates, echinoderms, insects , and molluscs. It is involved in the second phase of digestion, following mastication .The stomach is...

 can lead to a chemical peritonitis due to leaked gastric acid

Gastric acid

Gastric acid is a digestive fluid, formed in the stomach. It has a pH of 1 to 2 and is composed of hydrochloric acid , and large quantities of potassium chloride and sodium chloride...

. Perforation anywhere along the gastrointestinal tract is a surgical emergency

Surgical emergency

Surgical emergency is a medical emergency which requires immediate surgical intervention .The following conditions are surgical emergencies:* Acute trauma* Accidental amputation* Acute appendicitis...

.

Signs and symptoms

Sudden attack of pain in epigastrium

Epigastrium

The epigastrium is the upper central region of the abdomen. It is located between the costal margins and the subcostal plane....

 to the right of midline in case of perforation of duodenal ulcer. In case of gastric ulcer the pain is in epigastrium. There is history of burning pain in epigastrium, flatulence and dyspepsia

Dyspepsia

Dyspepsia , also known as upset stomach or indigestion, refers to a condition of impaired digestion. It is a medical condition characterized by chronic or recurrent pain in the upper abdomen, upper abdominal fullness and feeling full earlier than expected when eating...

. History of drug intake without sufficient food intake may be present. In case of intestinal perforation pain starts from the site of perforation, visceral, and then spreads all over the abdomen. In any case there is board like rigidity of abdomen, tenderness, and rebound tenderness. After sometimes the abdomen becomes silent, heart sounds can be heard all over. Patient stops passing flatus and motion, abdomen is distended.

Gastrointestinal perforation results in severe abdominal pain

Abdominal pain

Abdominal pain can be one of the symptoms associated with transient disorders or serious disease. Making a definitive diagnosis of the cause of abdominal pain can be difficult, because many diseases can result in this symptom. Abdominal pain is a common problem...

 intensified by movement, nausea

Nausea

Nausea , is a sensation of unease and discomfort in the upper stomach with an involuntary urge to vomit. It often, but not always, precedes vomiting...

 and vomiting

Vomiting

Vomiting is the forceful expulsion of the contents of one's stomach through the mouth and sometimes the nose...

. Later symptoms include fever

Fever

Fever is a common medical sign characterized by an elevation of temperature above the normal range of due to an increase in the body temperature regulatory set-point. This increase in set-point triggers increased muscle tone and shivering.As a person's temperature increases, there is, in...

 and or chills.

Causes

Underlying causes include gastric ulcer, appendicitis

Appendicitis

Appendicitis is a condition characterized by inflammation of the appendix. It is classified as a medical emergency and many cases require removal of the inflamed appendix, either by laparotomy or laparoscopy. Untreated, mortality is high, mainly because of the risk of rupture leading to...

, gastrointestinal cancer

Gastrointestinal cancer

Gastrointestinal cancer refers to malignant conditions of the gastrointestinal tract, including the esophagus, stomach, biliary system, pancreas, bowels, and anus. The symptoms relate to the organ affected, and can include obstruction , abnormal bleeding, or other associated problems...

, diverticulitis

Diverticulitis

Diverticulitis is a common digestive disease particularly found in the large intestine. Diverticulitis develops from diverticulosis, which involves the formation of pouches on the outside of the colon...

, superior mesenteric artery syndrome

Superior mesenteric artery syndrome

Superior mesenteric artery syndrome is a very rare, life-threatening gastro-vascular disorder characterized by a compression of the third portion of the duodenum by the abdominal aorta and the overlying superior mesenteric artery...

, trauma

Physical trauma

Trauma refers to "a body wound or shock produced by sudden physical injury, as from violence or accident." It can also be described as "a physical wound or injury, such as a fracture or blow." Major trauma can result in secondary complications such as circulatory shock, respiratory failure and death...

 and ascariasis

Ascariasis

Ascariasis is a human disease caused by the parasitic roundworm Ascaris lumbricoides. Perhaps as many as one quarter of the world's people are infected, with rates of 45% in Latin America and 95% in parts of Africa. Ascariasis is particularly prevalent in tropical regions and in areas of poor...

.
Typhoid fever, NSAID drugs,ingestion of corrosives may also be responsible.

Diagnosis

On X-rays, free gas may be visible in the abdominal cavity. The perforation can often be visualised using CT. White blood cells are often elevated. Also, the symptom of wooden belly is visible, i.e. abdominal wall rigidity.

Treatment

Treatment depends on the underlying cause. Surgical intervention is nearly always required in form of exploratory laparotomy and closure of perforation with peritoneal wash (Sometimes medical evacuation). Conservative treatment is indicated in case patient is nontoxic and clinically stable, these patients are to be treated with IV fluids, antibiotics, nasogastric aspiration and bowel rest. Consultation with a specialist is often needed.