INTESTINAL PERFORATION

Causes, Symptoms & Emergency Surgical Management

Emergency Abdominal Surgery in Thane – By Dr. Ankur Bhanushali

What Is Intestinal Perforation?

Intestinal perforation is a serious condition where a hole develops in the wall of the intestine, allowing intestinal contents to leak into the abdominal cavity. This can rapidly lead to severe infection and life-threatening complications.

Immediate surgical care is essential.

Why Intestinal Perforation Is a Medical Emergency

A perforation can cause:
✔ Severe abdominal infection (peritonitis)
✔ Blood poisoning (sepsis)
✔ Organ failure
✔ Shock

Delay in treatment can be fatal.

Common Causes of Intestinal Perforation

Intestinal perforation may occur due to:
✔ Typhoid fever
✔ Intestinal obstruction
✔ Peptic ulcer disease
✔ Appendicitis
✔ Diverticulitis
✔ Abdominal trauma
✔ Cancer of the intestine

Identifying the cause guides surgical planning.

Risk Factors for Bowel Perforation

Higher risk is seen in:
✔ Elderly patients
✔ Chronic steroid users
✔ Patients with tuberculosis
✔ Long-standing bowel disease
✔ Post-surgical patients

Early detection reduces complications.

Symptoms of Intestinal Perforation

Patients may experience:
✔ Sudden severe abdominal pain
✔ Abdominal rigidity
✔ Fever
✔ Vomiting
✔ Inability to pass stool or gas
✔ Rapid heartbeat

These symptoms need urgent evaluation.

Signs That Demand Immediate Surgery

Emergency intervention is required if there is:
✔ Free air in abdomen on X-ray
✔ Severe abdominal tenderness
✔ Signs of sepsis
✔ Falling blood pressure
✔ Altered mental status

Time is critical.

Diagnostic Evaluation

Diagnosis includes:
✔ Detailed clinical examination
✔ Blood investigations
✔ X-ray abdomen (air under diaphragm)
✔ CT scan abdomen

Imaging confirms perforation and severity.

Initial Stabilization Before Surgery

Before surgery, doctors focus on:
✔ IV fluids
✔ Broad-spectrum antibiotics
✔ Pain management
✔ Nasogastric tube insertion
✔ Correction of electrolytes

Stabilization improves surgical outcomes.

Surgical Treatment of Intestinal Perforation

Surgical options depend on severity:
✔ Primary repair of perforation
✔ Resection of diseased bowel
✔ Temporary stoma (if required)
✔ Peritoneal lavage

Early surgery saves lives.

Post-Surgical Recovery & ICU Care

After surgery, patients require:
✔ Intensive monitoring
✔ Infection control
✔ Nutritional support
✔ Gradual return of bowel function

Recovery depends on early intervention.

Possible Complications If Untreated

Untreated perforation may lead to:
✔ Severe peritonitis
✔ Septic shock
✔ Multi-organ failure
✔ Death

Prompt treatment is non-negotiable.