Gastrointestinal perforation

Question 1

Define

Answer 1

Hole in the wall of part of the gastrointestinal tract

Question 2

Aetiology/risk factors

Answer 2

Underlying causes include:

• Gastric ulcers
• Duodenal ulcers
• Appendicitis
• Gastrointestinal cancer
• Diverticulitis
• Inflammatory bowel disease
• Superior mesenteric artery syndrome
• Trauma
• NSAIDs
• Typhoid

Question 3

epidemiology

Answer 3

Children: blunt trauma
Adults:
Duodenal perforation more than gastric perforation

Question 4

symptoms

Answer 4

• History of penetrating issue
• NSAID or aspirin use
• Abdominal pain
• Vomiting
• Hiccuping
• History of travel
• Sharp severe sudden onset (perf peptic ulcer)

Question 5

signs

Answer 5

very unwell
signs of shock
pallor
pyrexia
dehydration
peritonitis 
loss of dullness (gas covers)

Question 6

investigations

Answer 6

• Bloods: WCC, CRP, Cultures, Group & Save, Cross Match, Amylase to rule out pancreatitis, ABG, LFT
• Urinalysis
• USS: Localised gas collection, thickens bowel loop
• CT: If no delay
• Plain AXR: Rigler’s sign, Visible falciform ligament RUQ -> umbilicus
• CXR if peritonitic or over 50: gas under diaphragm

Question 7

management

Answer 7

Laparoscopy
Laparotomy

correct iv fluids and electrolytes

iv antibiotics

Question 8

complications

Answer 8

Bleeding

• Sepsis
• Bowel infarction

large and small bowel - peritonitis

oesophageal - sepsis death and mediastinitis

Question 9

prognosis

Answer 9

Chances of recovery improve with early diagnosis and treatment