What causes gastrointestinal perforation?

Gastrointestinal Perforation, a.k.a., Ruptured Bowel, a.k.a., Discontinuity of the Bowel Wall, is a potentially devastating medical condition where a hole or rupture forms in the wall of the gastrointestinal tract, which includes the large and small intestines; the stomach and the esophagus. 

Symptoms include tenderness to touch and severe constant pain. Increased breathing and heart rate, acute mental confusion, fever and sepsis may also occur.

Causes of the condition:

1. Ischemia (inadequate blood supply): This can be Bowel Obstruction or Necrosis. Bowel obstruction is where enlargement of the bowel walls lead to the reduced blood supply and Necrosis; which is the death of cells due to lack of blood supply. Both of which can lead to rupture or perforation. This is more common among the elderly, specifically, among those with clotting disorders, coronary disease and a history of smoking.
2. Infection: 2 main causes are: Appendicitis, where the finger-shaped pouch projecting into the colon on the lower right side of the abdomen becomes inflamed; and Diverticulitis, where the small pouches that form on the side of the intestines become inflamed. It is believed that both these are due to entrapment of fecal matter, causing internal pressure and infection leading to perforation.
3. Erosive Diseases: These are those that wear out the body structure over a period of time in many ways, like ulcerous disease or invasive tumours. An ulcer directly damages the bowel wall due to infection, overproduction of acid or lack of acid protective mechanism. Tumours can form on the entire wall of the bowel leading to perforation.
4. Physical: This can be either external or internal trauma. External or mechanical injury can be caused by either blunt or penetrating trauma to abdomen during say, an accident or a fight. Internal are usually medical in nature, often caused by instrumentation, like during an endoscopy. 

This is a life-threatening medical emergency requiring immediate medical care, and early diagnosis and treatment lead to highly improved chances of recovery.

Blog Reviewed By: Dr Patta Radhakrishna

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