Gastrointestinal perforation

Last Updated on 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

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