Any of the hollow digestive organs may become perforated (punctured), which causes a release of gastrointestinal contents and leads to shock and death if surgery is not performed immediately.

• Symptoms include sudden severe pain in the chest or abdomen and an abdomen that is tender when touched.
• X-rays or computed tomography is used to make the diagnosis.
• Immediate surgery is needed.

A perforation allows food, digestive juices, or intestinal contents to leak into the abdomen (or sometimes the chest, if the esophagus is perforated). These materials are very irritating and contain bacteria, which cause severe inflammation and infection that are typically fatal if untreated.

Causes

Causes vary depending on the location of the perforation, but trauma can affect any part of the digestive system. Swallowed foreign bodies usually pass through a person without difficulty but occasionally become stuck and lead to perforation.

Some Causes of Perforation Area Of Perforation Causes Comments Anywhere along the digestive tract Trauma Foreign bodies Esophagus Forceful vomiting Called Boerhaave's syndrome Injury from a medical procedure Typically caused by an esophagoscope, balloon dilator, or bougie (a thin cylinder-shaped instrument) Swallowing strong corrosive material Such as battery acid or lye Stomach or small intestine (duodenum) Peptic ulcer disease About one third of people have had no previous ulcer symptoms Swallowing strong corrosive material Typically affects the stomach rather than the small intestine Intestine Strangulating obstruction Possibly acute appendicitis and Meckel's diverticulitis Obstruction High risk: people receiving prednisone or other immunosuppressants (these people may have few symptoms)

Symptoms

Perforation of the esophagus, stomach, or duodenum causes sudden severe pain, which may travel (radiate) to the shoulder. The person appears very ill, with rapid heart rate, sweating, and an abdomen that is tender and firm to the touch. Because perforation of the small or large intestine often occurs during the course of another painful condition, and is sometimes walled off, symptoms may be less dramatic and can be mistaken for a worsening of the original problem.

In all types of perforation, the person usually has nausea, vomiting, and loss of appetite.

Diagnosis and Treatment

The doctor usually takes x-rays of the chest and abdomen, which may show air that has leaked from the digestive system, a sure sign of perforation. Sometimes, the doctor needs to perform a computed tomography (CT) scan to confirm the diagnosis.

If doctors diagnose a perforation, immediate surgery is needed. Before surgery, the person receives intravenous fluids and antibiotics. Also, a small tube is placed through the nose into the stomach to suction out stomach juices so they do not flow out the perforation.

Last full review/revision September 2007 by Parswa Ansari, MD