Perforation is a hole that develops through the wall of a body organ. This problem may occur in the esophagus, stomach, small intestine, large intestine, rectum, or gallbladder.
Perforation of an organ can be caused by a variety of factors. These include:
It may also be caused by surgery in the abdomen or procedures such as colonoscopy or upper endoscopy.
Perforation of the intestine or other organs causes the contents to leak into the abdomen. This causes a severe infection called peritonitis.
Symptoms may include:
X-rays of the chest or abdomen may show air in the abdominal cavity. This is called free air. It is a sign of a tear. If the esophagus is perforated free air can be seen in the mediastinum (around the heart) and in the chest.
A CT scan of the abdomen often shows where the hole is located. The white blood cell count is often higher than normal.
Treatment most often involves emergency surgery to repair the hole.
In rare cases, people can be treated with antibiotics alone if the perforation has closed. This can be confirmed by a physical exam, blood tests, CT scan, and x-rays.
Surgery is successful most of the time. However, the outcome will depend on how severe the perforation is, and for how long it was present before treatment. The presence of other illnesses can also affect how well a person will do after treatment.
Even with surgery, infection is the most common complication of the condition. Infections can be either inside the abdomen (abdominal abscess or peritonitis), or throughout the whole body. Body-wide infection is called sepsis. Sepsis can be very serious and can lead to death.
Call your health care provider if you have:
People will often have a few days of pain before the intestinal perforation occurs. If you have pain in the abdomen, see your provider right away. Treatment is much simpler and safer when it is started before the perforation occurs.
Reviewed By: Michael M. Phillips, MD, Clinical Professor of Medicine, The George Washington University School of Medicine, Washington, DC. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.