Intestinal perforation: symptoms, causes and treatments


The colon is made up of layers of smooth muscle and mucous membranes. The innermost layer, called the mucosa, is soft and flexible, similar to the tissues of the mouth. Bowel perforation occurs when a hole is made in this lining, often as a result of colon surgery or severe bowel disease.

The opening in the colon allows the contents of the colon to leak into the normally sterile contents of the abdominal cavity. Bowel perforation is considered a medical emergency and requires immediate treatment.

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Bowel perforation symptoms

Symptoms of intestinal perforation can vary and appear slowly or quickly, depending on the underlying cause. Symptoms can include :

  • Abdominal pain (often severe and diffuse)
  • Severe abdominal cramps
  • Swelling
  • Nausea and vomiting
  • Change in bowel movements or habits
  • Rectal bleeding
  • Fever (usually not immediately)
  • Shaking chills
  • Fatigue

Seek emergency care if you have symptoms of a bowel perforation.


If left untreated, intestinal contents can leak out and cause inflammation, infection, and even abscesses in the abdomen. The technical name for this is peritonitis , which is a painful precursor to sepsis , or whole-body infection.

Complications from an untreated piercing can include:

  • Bleeding
  • Infection (peritonitis and sepsis )
  • Death

Complications depend on the person's general health, as well as how long it took to diagnose and treat the piercing.


Intestinal perforation can occur spontaneously (unexpectedly) as a result of disease or, instead, it can be a complication of various diagnostic and surgical procedures that accidentally create a hole in the colon. Trauma, especially blunt trauma to the abdomen, is also a major cause of intestinal perforation.

Reasons associated with the procedure

Reasons associated with the procedure include:

  • Enema : A rectal enema tube inserted incorrectly or forcibly can break or push through the lining of the colon.
  • Preparing the bowel for colonoscopy : In rare cases, preparing the bowel for colonoscopy can lead to a perforation. It is more common in people with a history of constipation .
  • Rigmoidoscopy : Although the flexible sigmoidoscopy endoscope is flexible, perforation is still a risk, but it is rare.
  • Colonoscopy – The tip of the scope can pass through the lining of the colon, although this is a rare complication of the procedure and is not seen with virtual colonoscopy . Colonoscopy-associated bowel perforation is more common in people with severe acute bowel disease and those taking steroid medications .
  • Abdominal or pelvic surgery: Colon surgery in particular, as with colon cancer, may have a risk of perforation .

The incidence of perforation during colonoscopy is about 1 in 1,400 people who have a screening colonoscopy and 1 in 1000 people who have a therapeutic colonoscopy (for example, to remove a polyp) .

Spontaneous causes

Causes of spontaneous bowel perforation (not related to surgery or procedures) include:

  • Inflammatory bowel disease / colitis such as Crohn's disease and ulcerative colitis . The lifetime risk of a bowel perforation in Crohn's disease ranges from 1% to 3%, making it a very common cause .
  • Severe intestinal obstruction , especially if the colon is "weakened" by diverticular disease, another process, or cancer.
  • Injury
  • Ischemic bowel disease (when the blood supply to the large intestine is disturbed)
  • Colon cancer
  • Ingestion of a foreign body, most often due to ingestion of fish bones and bone fragments, as well as non-food items .
  • Severe intestinal obstruction

Risk factor's

Scientists have discovered that several factors can increase the risk of developing a bowel perforation. These include both factors associated with the operation or procedure (iatrogenic causes) and intestinal diseases characterized by inflammation .

Risk factors can include:

  • Recent or previous abdominal surgery
  • Previous or recent pelvic surgery
  • Age over 75 years
  • History of multiple medical problems.
  • Injury to the abdomen or pelvis (such as in a car accident )
  • History of diverticular disease
  • History of inflammatory bowel disease
  • Colon cancer
  • Use of the drug for immunotherapy with monoclonal antibodies ipilimumab.
  • Pelvic adhesions (scar tissue usually associated with previous surgeries)
  • Female gender (women tend to have a more flexible colon, which can lead to accidental perforation during medical procedures, including colonoscopy)
  • Diagnostic and surgical procedures involving the digestive tract, abdomen, or pelvis.

Risk factors for perforation during colonoscopy include femininity, old age, a history of diverticular disease, and intestinal obstruction .


If your doctor suspects a bowel perforation, he may order tests to confirm the suspicion. A plain abdominal x-ray may show gas outside the colon, but it is not always diagnostic. An abdominal CT scan with or without contrast, barium enema, or swallowing may be required.

A complete blood count (CBC) may show an increase in the white blood cell count if the perforation is present for a while or signs of anemia due to bleeding. Sometimes it may take several imaging studies and time to accurately diagnose small perforations.

Watch out

Most piercings are repaired with surgery. Depending on the location and size of the tear, your doctor may correct it with an endoscope similar to the one used during colonoscopy, but this is not an option for everyone.

Open bowel surgery may or may not result in a stoma and colostomy , an artificial opening outside the stomach through which stool drains into a small sac until the intestines heal.


During the initial recovery period, you will not be able to drink or eat anything by mouth. This is called bowel rest, and it allows time for the inner lining to heal properly.

You will also have a nasogastric tube to drain stomach contents for a period of time. If you are in the hospital, you may be given antibiotics through a vein and fed for several days.

While you may work to get back to your normal daily routine, it's important to give your gut time to heal properly and to follow your doctor's instructions.

Get the word of drug information

Bowel perforation can occur spontaneously, for example, with inflammatory bowel disease, during surgery or diagnostic tests. Symptoms can appear quickly or slowly and should be considered in anyone with risk factors for perforation in combination with risk factors for the disease.

With early detection, several treatment options are available, but even with surgery (which is most often required), the intestines can often be preserved and healed without a colostomy. Recovery can take time, both for healing and for eliminating the risk factors that led to the piercing.

Frequently asked questions

  • If someone receives immediate treatment for a bowel perforation, it will not affect their lifespan in any way. However, if the condition is not treated and the person develops sepsis, the chances of dying or developing a life-changing condition are high. About one-third of people who develop sepsis die, and those who survive may suffer from post-traumatic stress disorder, amputation, chronic pain, or organ failure.

  • Most of the time, a person feels physically due to a bowel perforation; It is an intense abdominal pain, although chills, fever and nausea are also symptoms.

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