intestinal perforation

Introduction

Perforation of the intestine

Etiology

• endoscopy
• appendicitis
• erlotinib (Tarceva)
• fish bone

Pathology

• performation of the proximal GI tract (stomach, proximal small bowel, biliary tree) involves gram-positive & gram-negative aerobic & facultative bacteria, but may also involve obligate anaerobes (Bacteroides sp.) when associated with abscess, ileus, or intestinal obstruction
• perforation of the colon generally involves facultative organisms (E. coli), obligate anaerobes (Bacteroides sp.), S. milleri, & enterococci

Clinical manifestations

• perforation of the descending colon generally manifests as subacute peritonitis

Radiology

• abdominal computed tomography
• plain abdominal films: pneumoperitoneum

Management

• surgical emergency
  • for perforated bowel due to diverticulitis, surgical resection comparable to peritoneal lavage in complications (26-31%) & overall mortality (12-14%), but less likely to need reoperation & sigmoid colon cancers may be revealed during surgery
• empiric antibiotic coverage: see appendicitis

More general terms

• intestinal disease
• gastrointestinal perforation