It is very important to know that perforated bowel is a medical emergency. Now let us understand what is meant by perforated bowel, what its causes are and how to deal with it. Perforated bowel means when a small hole forms in the small intestine or large intestine.
The content present in the intestine such as food, intestinal juices or even stool leaks in the peritoneum (covering of the abdominal cavity) resulting into a condition called acute abdomen or peritonitis. Perforated bowel can lead to sepsis or blood infection which can be fatal when not treated on time.
Causes Of Perforated Bowel
- Trauma: the Intestine can rupture with an external wound; the most frequent cause is a blow on the abdomen as in a car accident where the seatbelt can damage the gastrointestinal system. Penetration of sharp object in the abdomen can result into perforated bowel.
- Crohn’s disease: it is an inflammatory bowel disease.
- Acute appendicitis: inflammation of appendix can lead to perforation.
- Insertion of large objects in the anus such as a colonoscope, or improper insertion of enema tube in the anus.
- Diverticulitis: in this condition there are small pouches in the colon that get infected. This infection when not cured can block the colon and perforation is one of its complications.
- Intestinal amebiasis: it is a parasitic infection in the intestine that can lead to appendicitis and perforation.
- Typhoid fever: the small ulcers present on the wall of small intestine called payer’s patches can get perforated.
- Peptic ulcer: perforation of duodenal ulcer is common cause for acute abdomen.
Symptoms Of Perforation Of The Bowel
- Severe abdominal pain which is not relieved by medications. The pain is so severe that the person does not allow the abdomen to be touched. There is rebound tenderness and rigidity of the abdomen.
- Pain in the abdomen increases on slightest movement.
- Distension: distension of abdomen is another important symptom of perforated bowel. There is gaseous distension of abdomen. It may give a feeling of fullness.
- Fever with chills. There is high rise of temperature.
- Vomiting and nausea.
- Tachycardia, increased pulse rate.
- Low blood pressure.
- Abdominal sounds not heard on stethoscope.
Treatment For Perforated Bowel
As said earlier, the condition requires immediate medical attention. It is an emergency. A detailed history and physical examination aided with X-ray, CT scan, and blood examination will help the physician to diagnose the condition.
X-ray in standing position will show:
- Free gas under the diaphragm.
- Increase in white blood cells.
- CT scan can reveal perforation.
- When the condition is diagnosed surgery is the only option in most of the cases.
- Exploratory laparotomy is performed, the peritoneum is washed and the surgeon searches the whole of intestine for perforation.
- Once the perforated bowel is found the surgeon repairs it.
- Sometimes colostomy is required when perforation is in the large colon. Colostomy is a procedure where the large intestine is brought into the abdominal wall and the waste material is excreted into the bag attached outside of the abdomen. This procedure is temporary.
- Strong antibiotics may be administered to curtail sepsis.
- Vital signs such as respiration, heart rate and blood pressure are continuously monitored post operatively.
- The recovery time depends on the condition of the patient; however continuous follow up is needed for treating the underlying disease that has caused perforated bowel.