Bowel Perforation Management Flashcards
What are the symptoms of bowel perforation?
Severe abdominal pain
Shoulder tip pain
Symptoms may indicate the presence of perforation in the gastrointestinal tract.
What are the common causes of upper gastrointestinal tract perforation?
- Peptic Ulcer Disease
- Gastric or oesophageal cancer
- Foreign body ingestion (e.g. battery)
- Boerhaave syndrome (spontaneous esophageal rupture)
List some causes of lower gastrointestinal tract perforation.
- Diverticulitis
- CRC
- Appendicitis or Meckel’s diverticulitis
- Severe colitis (e.g. Crohn’s)
- Toxic megacolon
- Closed loop obstruction
What are possible causes of perforation in any part of the gastrointestinal tract?
- Iatrogenic (gastroscopy or colonoscopy)
- Trauma
- Mesenteric ischemia
- Obstructing lesions
These causes can lead to perforation regardless of the GIT segment.
What are the key findings in an abdominal examination for bowel perforation?
- Abdominal pain
- Peritonism (localized or generalized)
- Guarding
- Rebound tenderness
- Absent bowel sounds
These findings suggest irritation or inflammation in the abdominal cavity.
What does generalized peritonitis imply during an abdominal exam?
Diffuse contamination of the abdomen
A rigid abdomen is often indicative of generalized peritonitis.
What blood tests are typically conducted to investigate bowel perforation?
- FBC
- CRP
- U&E
- Coag
- Group and hold
- Amylase
- BhCG (to rule out obstetric causes)
- VBG (lactate raised in ischemia)
What is the first-line imaging investigation for suspected bowel perforation?
CT abdomen with IV contrast
This imaging is crucial for confirming the diagnosis.
XRAY signs of bowel perforation?
Rigler’s sign (both sides of the bowel visible due to free air)
Psoas sign (loss of the sharp delineation of the psoas muscle border)
These signs indicate the presence of free air in the abdominal cavity
What are the initial treatment steps for bowel perforation?
- Make NPO +/- insert NTG
- Fluid resuscitation
- IV antibiotics
- Analgesia
- Antiemetics
Under what conditions is conservative treatment indicated for bowel perforation?
- Physiologically well patients
- Localized diverticular perforation with only localized peritonitis and tenderness, and no evidence of generalized contamination
Conservative measures may be appropriate in select cases.
What surgical treatments may be required for a perforated viscus?
Exploratory laparotomy + Peritoneal lavage + Repair of the perforation
What is the management for a duodenal ulcer perforation?
Omental patch repair (Graham repair)
This technique is commonly used for duodenal ulcers.
What surgical approach is taken for gastric ulcer perforation?
Resection
Resection may be necessary to remove the affected tissue.
What is the treatment for small bowel perforation?
- Bowel resection
- Primary anastomosis +/- stoma formation
The approach depends on the extent of the perforation.
What is the surgical management for large bowel perforation?
- Bowel resection +/- stoma formation
- Right hemicolectomy for acute appendicitis
- Hartmann’s / primary anastomosis for closed loop obstruction or diverticulitis
- Resection + defunctioning loop for CRC
These options vary based on the specific condition causing perforation.
