Gastrointestinal perforation , also known as intestinal rupture , is a hole in the wall part of the gastrointestinal tract. The digestive tract includes the esophagus, stomach, small intestine, and colon. Symptoms include severe abdominal pain and tenderness. When a hole in the stomach or the first part of the small intestine, the onset of pain is usually abruptly temporary with a hole in the onset of the colon may be more gradual. Pain is usually constant in nature. Sepsis, with elevated heart rate, increased respiratory rate, fever, and confusion may occur.
Causes may include trauma such as knife wounds, sharp intakes, or medical procedures such as colonoscopy, intestinal obstruction such as from volvulus, colon cancer, or diverticulitis, ulcers, intestinal ischemia, and a number of infections. including C. difficile . The hole allows the intestinal contents into the abdominal cavity. The entry of bacteria produces a condition known as peritonitis or in the formation of an abscess. Hole in the abdomen can also cause chemical peritonitis due to stomach acid. CT scans are usually the preferred diagnostic method; However, the free air of perforation is often seen in plain photographs.
Perforation anywhere along the gastrointestinal tract usually requires emergency surgery in the form of an exploratory laparotomy. This is usually done along with intravenous fluids and antibiotics. A number of different antibiotics may be used such as piperacillin/tazobactam or a combination of ciprofloxacin and metronidazole. Sometimes the holes can be stitched closed while other times required bowel resection. Even with the maximum treatment, the risk of death can reach 50%. Holes of gastric ulcer occur in about 1 per 10,000 people per year, while one from diverticulitis occurs in about 0.4 per 10,000 people per year.
Video Gastrointestinal perforation
Signs and symptoms
Signs and symptoms may include sudden pain in the epigastrium to the right of the midline indicating perforation of the duodenal ulcer. In perforation the gastric ulcer creates a history of burning pain in the epigastrium, with flatulence and disturbed digestion.
In intestinal perforation, pain begins from the perforation site and spreads throughout the abdomen.
Gastrointestinal perforation causes severe abdominal pain intensified by movement, nausea, vomiting, and hematemesis. The next symptoms are fever and/or chills. In any case, the stomach becomes stiff with tenderness and rebound tenderness. After a while the stomach becomes silent and the heart sounds everywhere. Patients stop using flatus and movement, distended stomach.
The symptoms of esophageal rupture may include sudden chest pain.
Maps Gastrointestinal perforation
Cause
Underlying causes include gastric ulcers, duodenal ulcers, appendicitis, gastrointestinal cancer, diverticulitis, inflammatory bowel disease, superior mesenteric artery syndrome, trauma and ascariasis. Typhoid fever, non-steroidal anti-inflammatory drugs, corrosive consumption may also be responsible.
Diagnosis
In x-rays, the gas can be seen in the abdominal cavity. The gas is easily visualized on x-rays when the patient is in an upright position. Perforation can often be visualized using computed tomography. White blood cells often increase.
Treatment
Surgical intervention is almost always necessary in the form of laparotomy of exploration and perforation closure by peritoneal leaching. Sometimes they can be managed laparoscopically.
Conservative treatment including intravenous fluids, antibiotics, nasogastric aspiration and intestinal rest are indicated only if the person is non-toxic and clinically stable.
References
External links
- Gastrointestinal perforation - MedlinePlus
Source of the article : Wikipedia
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