Gastrointestinal perforation history and symptoms
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mohammed Abdelwahed M.D[2]
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Overview
History
- The history of prior instrumentation, surgery, malignancy, or ingested foreign bodies
- Medical conditions such as peptic disease or medical device implants
- History of medications such as nonsteroidal anti-inflammatory drugs or glucocorticoids.
Presentations
- Acute symptoms associated with free perforation depend upon the nature and location of perforation:
- Cervical esophageal perforation
- Pharyngeal or neck pain: Pain radiating to the shoulder
- Odynophagia
- Dysphagia
- Because the pH of gastric contents is 1 to 2 along the gastric luminal surface, a sudden release of this acid into the abdomen causes severe and sudden peritoneal irritation and severe pain.
- The leakage of small intestinal contents into the peritoneal cavity may also cause severe pain, and for this reason, any severe pain after, particularly, a laparoscopic procedure should cause the surgeon to suspect leakage.
- Abdominal mass
- It is not uncommon for perforation to lead to abscess or phlegmon formation that can be appreciated on examination as an abdominal mass or with abdominal exploration. Diverticulitis is the most common etiology leading to intra-abdominal abscess formation.
- Fistula formation
- Fistulas are often related to inflammatory bowel diseases such as Crohn disease.
- Patients who develop an external fistula will complain of the sudden appearance of drainage from a postoperative wound, or from the abdominal wall or perineum in the case of spontaneous fistulas.
- Sepsis
- Sepsis can be the initial presentation of perforation, but its frequency is difficult to determine.
- ill appearing
- hemodynamically unstable
- altered mental status
- Organ dysfunction including acute respiratory distress syndrome, acute kidney injury, and disseminated intravascular coagulation may be present.
- Spontaneous intestinal perforation and necrotizing enterocolitis are gastrointestinal complications that typically occur in
- very low birth weight and extremely low birth weight
- preterm infants with a gestational age between 25 and 27 weeks