Bowel perforation

Last medical review:

A bowel perforation is a hole in the wall of the small intestine or the colon. The small intestine is the long, tube-shaped organ in the abdomen that receives partially digested food from the stomach and passes digested food to the large intestine. The colon is the longest part of the large intestine.

Food, digestive juices, bacteria or waste (poop or stool) can leak from the hole in the intestine. This can cause a collection of pus (called an abscess). When the contents of the intestine leak into the peritoneal cavity, it can lead to an infection (called peritonitis). The infection can enter the blood and may cause a widespread infection of the blood (called septic shock).

A bowel perforation is a serious condition that needs to be treated right away.

Causes

A bowel perforation can be caused by:

  • a tumour that grows through the wall of the intestine
  • a tumour in the wall of the intestine that quickly shrinks during chemotherapy and leaves a hole
  • some chemotherapy drugs, including bevacizumab (Avastin), imatinib (Gleevec), temsirolimus (Torisel) and sorafenib (Nexavar)
  • radiation therapy to the pelvis or abdomen, which can weaken the muscle wall of the intestine and cause a hole to form
  • a blockage of the small intestine or colon (called a bowel obstruction)
  • non-cancerous diseases
  • an accident, injury or swallowing a foreign object

In rare cases, surgery or an endoscopy can make a hole in the intestine.

Symptoms

Symptoms of a bowel perforation include:

  • sudden and severe abdominal pain
  • nausea and vomiting
  • fever
  • chills
  • swelling and bloating of the abdomen

Tell your doctor or healthcare team right away if you have these symptoms.

Diagnosis

Your doctor will try to find the cause of a bowel perforation. This may include asking questions about your symptoms, medicines you are taking and treatments you’ve had.

The doctor will examine your abdomen to look for any swelling or tightness. The doctor will also listen to your abdomen. If you have a bowel perforation, there will be no sounds of digestion (also called bowel sounds).

You may have the following tests and procedures:

  • a CT scan to try to find the hole
  • an upper gastrointestinal (GI) endoscopy or a colonoscopy to also help find the hole
  • an x-ray to look for air in the abdominal cavity or an ultrasound to look for air in the peritoneal cavity, which are both signs of a hole or tear in the intestine
  • a complete blood count (CBC) to see if you have an infection
  • blood tests to look for bacteria

Treatment

Most bowel perforations are treated with surgery to repair the hole. The surgeon will also remove the fluids and waste that has leaked into the abdomen.

Sometimes people with a bowel perforation are not healthy enough to have surgery. In these cases, the healthcare team may carefully watch the hole to see if it heals on its own. They may place a tube in the abdomen to drain fluids to help with healing.

The healthcare team will give you antibiotics to treat or lower the risk of infection.

Expert review and references

  • Elijah Dixon, MD, MSc(Epi), FRCSC, FACS