Gastrointestinal Perforation

Question 1

Define Gastrointestinal Perforation

Answer 1

Ruptured bowel leaving a hole in the wall of part of the GI tract

Question 2

Aetiology of Gastrointestinal Perforation (according to site)

Answer 2

All sites: trauma, foreign body, iatrogenic
Oesophagus: Boerhaave perforation, ingestion of corrosive material
Stomach/duodenum: peptic ulcers, ingestion of corrosive material
Intestine: obstruction, acute appendicitis, Meckel diverticulitis
Colon: obstruction (volvulus, cancer), diverticulitis, IBD, toxic megacolon
Gallbladder: acute cholecystitis

Perforation -> bacteria enters the abdominal cavity -> peritonitis and abscess formation

Question 3

Symptoms of Gastrointestinal Perforation

Answer 3

Abdominal pain (starts from site of perforation and spreads | sudden if UGI, gradual in large intestine | pain may radiate to the shoulder) 
Nausea and vomiting 
Anorexia 
Haematemesis, melaena
Sepsis -> fever and confusion

Question 4

Signs of Gastrointestinal Perforation on examination

Answer 4

Peritonitis: rigid abdomen, tender, rebound tenderness, lying still
Absent bowel sounds

Sepsis -> tachycardia, tachypnoea, fever , confusion

Question 5

Investigations for Gastrointestinal Perforation

Answer 5

FBC: raised WBC

CT/erect CXR: pneumoperitoneum
AXR: pneumoperitoneum, Rigler’s sign (free-intra abdominal gas adjacent to gas-filled loop of bowel, bowel wall well-defined)
Abdominal CT: pneumoperitoneum

Question 6

Management of Gastrointestinal Perforation

Answer 6

1. NBM
2. IV fluids
3. Antibiotics
4. Emergency surgery (drain any abscesses, exploratory laparotomy to sew perforation closed ± bowel resection)

Question 7

Complications of Gastrointestinal Perforation

Answer 7

Peritonitis

Sepsis