Bowel perforation

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 (stool or feces) 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.


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, leaving a hole
  • 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)
  • some chemotherapy drugs, including bevacizumab (Avastin), imatinib (Gleevec), temsirolimus (Torisel) and sorafenib (Nexavar)
  • non-cancerous diseases
  • accidents

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


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.


Your doctor will try to find the cause of 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 for bowel sounds because there will be no sounds of digestion if you have a bowel perforation.

You may have the following tests:


Most bowel perforations are treated with surgery to repair the hole. The surgeon will also remove the fluids and waste products that have 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