Last Updated on December 31, 2018 by FRCEM Intermediate

Signs and Symptoms

• Acute onset of severe, constant abdominal pain
• Generalized peritonism
  • guarding
  • rigidity
  • percussion tenderness
  • rebound tenderness
  • absent bowel sounds

Causes of GI perforation

• Duodenal ulceration
• Gastric ulceration
• Gastric carcinoma
• Traumatic e.g. fishbone perforation, colonoscopy
• Ischaemic (usually secondary to gastric volvulus)
• Trauma
• Diverticular disease
• Colonic malignancy
• Bowel obstruction
• difficile colitis
• Inflammatory bowel disease

Other causes of pneumoperitoneum

• Recent surgery
• Peritoneal dialysis
• Gas-forming infections
• Vaginal gas insufflation during water-skiing or oral sex

Investigations

• FBC, U&E, LFTs, Lactate, Amylase Glucose, clotting
• Erect CXR – looking for free gas under the diaphragm
• CT abdomen
• Urine analysis

Emergency management

• Large caliber IV access and Send blood for FBC, U&E, LFTs, Glucose, clotting
• IV fluid resuscitation
• IV analgesia +/- antiemetic
• IV broad-spectrum antibiotics
• Catheterise and monitor fluid balance
• NBM
• Urgent surgical referral
• Definitive management dependent on the cause