Patient education: Gastrointestinal tract perforation (The Basics)

What is a gastrointestinal tract perforation? — The gastrointestinal tract, or "GI tract," includes all of the organs in the body that digest food (figure 1). A "perforation" means a hole in 1 of these organs.

The GI tract includes the:

●Esophagus (the tube that connects the mouth to the stomach)

●Stomach

●Small intestine (also known as the small bowel)

●Large intestine (also known as the colon or large bowel)

When you have a hole in your GI tract, air, digestive juices, and partially digested food can leak out. This can cause irritation or infection. A GI tract perforation is a serious problem that can even cause death.

What can cause a GI tract perforation? — Many things can cause a hole in the GI tract. Examples include:

●Swallowing an object like a toothpick or chicken bone

●Certain medicines such as aspirin or ibuprofen

●Surgery or procedures like an upper endoscopy (a test that looks at the upper GI tract) or colonoscopy (a test that looks at the large intestine)

●Diseases that affect the GI tract such as Crohn disease, ulcerative colitis, peptic ulcers, appendicitis, or diverticulitis

●Cancer of the GI tract

●Infections such as tuberculosis

●Injuries from an accident or other type of trauma

What are the symptoms of a GI tract perforation? — The symptoms of a GI tract perforation might start suddenly or more slowly. The symptoms depend on things like the location of the hole or if fluids leak out into the belly.

Symptoms can include:

●Pain – The pain might be sudden and severe, or change over time. Some people have pain in their chest or belly, and others feel pain in their neck or back.

●A swollen and tender belly

●Nausea and vomiting

●Fever and chills

●Fast heart rate and low blood pressure

●Confusion

Will I need tests? — There are several tests doctors can do, but they might not all be needed. The doctor will do an exam and then decide if tests are needed.

Tests can include:

●Blood tests

●Imaging tests – These might include X-rays, ultrasounds, or CT scans of the chest, belly, or neck. Imaging tests create pictures of the inside of the body.

●Endoscopy – This is a test that uses a thin tube with a camera to see inside the body (figure 2).

How is a GI tract perforation treated? — A GI tract perforation can make you very sick. You might need to be in an intensive care unit, or "ICU," where the staff can monitor you. Until your GI tract has healed, you will not be allowed to eat.

The exact treatment depends on where the hole is in your GI tract. It usually includes:

●Fluids through an IV (a thin tube that goes into a vein)

●Strong antibiotics through an IV

Some people need surgery to treat the perforation. This also gives your doctor a chance to clean out anything that has leaked out of your GI tract.

To treat some perforations, the doctor might need to take out some of the intestine. Sometimes, they can then reconnect the intestine. In other cases, they might need to connect the intestines to an opening in the belly, called an "ostomy" (figure 3). If you have an ostomy, your bowel movements will exit your body through this opening, rather than through your anus. An ostomy might be needed for a short time to help your intestine to heal, or it might be permanent.

You might not be able to eat for some time after surgery. This is so your GI tract can heal. If you cannot eat, you might need to get nutrition through an IV or a feeding tube. A feeding tube might go in your nose and into your stomach, or through your skin directly into your stomach or small intestine.

More on this topic

Patient education: Upper endoscopy (The Basics)
Patient education: Colonoscopy (The Basics)
Patient education: Crohn disease in adults (The Basics)
Patient education: Crohn disease in children (The Basics)
Patient education: Ulcerative colitis in adults (The Basics)
Patient education: Ulcerative colitis in children (The Basics)
Patient education: Peptic ulcers (The Basics)
Patient education: Appendicitis in adults (The Basics)
Patient education: Appendicitis in children (The Basics)
Patient education: Diverticulitis (The Basics)
Patient education: Colon and rectal cancer (The Basics)
Patient education: Colostomy or ileostomy surgery (The Basics)

Patient education: Upper endoscopy (Beyond the Basics)
Patient education: Colonoscopy (Beyond the Basics)
Patient education: Crohn disease (Beyond the Basics)
Patient education: Ulcerative colitis (Beyond the Basics)
Patient education: Peptic ulcer disease (Beyond the Basics)
Patient education: Diverticular disease (Beyond the Basics)
Patient education: Colon and rectal cancer (Beyond the Basics)