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Gastrointestinal perforation is a hole that develops through the entire wall of the stomach, small intestine, large bowel, or gallbladder. This condition is a medical emergency.

Gastrointestinal perforation can be caused by a variety of illnesses, including appendicitis, diverticulitis, ulcer disease, gallstones or gallbladder infection, and less commonly, inflammatory bowel disease, including Crohn's disease and ulcerative colitis.

Perforation of the intestine leads to leakage of intestinal contents into the abdominal cavity. This causes an inflammation called peritonitis.

Symptoms may include:

• Abdominal pain - severe
• Chills
• Fever
• Nausea
• Vomiting

X-rays of the abdomen may show air in the abdominal cavity (not in the stomach or intestines), suggesting a perforation. CT scan of the abdomen often shows the location of the perforation. The person's white blood cell (WBC) count is often higher than normal.

Treatment usually involves surgery to repair the hole (perforation). Occasionally, a small part of the intestine must be removed. A temporary colostomy or ileostomy may be needed.

In rare cases, antibiotics alone can be used to treat patients whose perforations have closed. This can be confirmed by a physical exam, blood tests, CT scan, and x-rays.

Surgery is usually successful, but depends on the severity of the perforation and the length of time to treatment.

Complications include:

• Bleeding
• Infection (possible, sepsis)
• Intra-abdominal abscess

Call your doctor if you have severe abdominal pain, fever, nausea, vomiting, blood in your stool, or changes in bowel habits.

Prevention depends on the cause. Diseases that may lead to intestinal perforation should be treated appropriately.

Intestinal perforation; Perforation of the intestines

Turnage RH, Richardson KA, Li BD, McDonald JC. Abdominal wall, umbilicus, peritoneum, mesenteries, omentum, and retroperitoneum. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 18th ed. St. Louis, Mo: WB Saunders; 2008:chap 43.

Updated by: Jacob L. Heller, MD, Emergency Medicine, Virginia Mason Medical Center, Seattle, Washington, Clinic. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.