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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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