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Gastrointestinal Perforation

A cousin was rushed to a hospital during the lockdown and was diagnosed to have gastrointestinal perforation. Kindly shed light on the causes and remedy.

Maduqa V.

Gastrointestinal Perforation (GP) happens when a hole forms all the way through the stomach, large bowel or small intestine.

GP is an emergency that requires immediate medical care. The condition is life-threatening. It can also be called intestinal perforation or perforation of the intestines.

It can be due to a number of diseases, including appendicitis, ulcer and diverticulitis. It can also be the result of trauma, such as a knife wound or gunshot wound. A perforation may also occur in the gallbladder. This can have symptoms that are similar to the symptoms of GP. A hole in the gastrointestinal system or gallbladder can lead to peritonitis.

Peritonitis is the inflammation of the membrane that lines the abdominal cavity; and occurs when any of the following enters the abdominal cavity:

  1. 1. Bacteria
  2. 2. Bile
  3. 3. Stomach acid
  4. 4. Partially digested food
  5. 5. Stool

When one has GP and peritonitis occurs, the abdomen feels very tender. Pain often worsens when someone touches or palpates the area or when the patient moves. Pain is generally better when lying still.

In addition to the general symptoms of perforation, symptoms of peritonitis may include:

  1. 1. Fatigue
  2. 2. Passing less urine, stool or gas
  3. 3. Shortness of breath
  4. 4. Fast heartbeat and dizziness

Some causes of the perforation are:

  1. 1. Appendicitis; which is more common among older persons.
  2. 2. Diverticulitis; which is a digestive disease
  3. 3. Stomach ulcer
  4. 4. Gallstones
  5. 5. Gallbladder infection
  6. 6. Inflammatory bowel diseases such as Crohn’s disease or ulcerative colitis, which is less common
  7. 7. Inflamed Meckel’s diverticulum; which is a congenital abnormality of the small intestine that is similar to the appendix.
  8. 8. Cancer in the gastrointestinal tract.

The condition may also be due to:

  1. 1. Blunt trauma to the abdomen
  2. 2. A knife or gunshot wound to the abdomen
  3. 3. Abdominal surgery
  4. 4. Stomach ulcer
  5. 5. Ingestion of foreign objects or caustic substances
  6. 6. Rarely, the condition may occur due to bowel injuries from an endoscopy or colonoscopy.

Diagnosis

X-rays to check for air in the abdominal cavity. CT scan to get a better idea where the perforation might be. Also, blood samples are taken to look for signs of infection, as well as assessment of kidney and liver functions.

Complications include:

  1. 1. Bleeding
  2. 2. Sepsis; which is a life-threatening bacterial infection
  3. 3. Abscesses in the belly
  4. 4. Wound infection
  5. 5. Bowel infarction; which is the death of part of the bowel.

Another complication is wound failure which may occur in some cases. “Wound failure” means the wound cannot or does not heal.

Factors that increase the risk of this include:

  1. 1. Malnutrition or poor diet and smoking and excessive alcohol use
  2. 2. Drug abuse
  3. 3. Poor hygiene and sepsis
  4. 4. Obesity
  5. 5. Hematoma; which occurs when blood collects outside the blood vessels
  6. 6. Type 2 diabetes
  7. 7. Steroid therapy or the use of corticosteroids which are anti-inflammatory drugs that suppress the immune system and can mask an ongoing infection and delay diagnosis.

Treatment options:

  • People with GP often require emergency surgery. This will usually involve an exploratory laparotomy. The surgeon will open up the person’s abdomen and repair any holes in the gastrointestinal tract and remove any substances in the abdomen. This helps to treat the peritonitis and prevent sepsis.
  • On rare occasions, a GP may heal on its own and not require surgery. If this occurs, a course of antibiotics may be the only treatment.

 

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