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 of recent instrumentation, surgery, or ingested foreign bodies is usually related to gastrointestinal tract (GIT) perforation. Main symptoms are pains in chest or abdomen, abdominal mass, dysphagia, fistula formation, or sepsis.
History of GIT perforation
- History of recent instrumentation, surgery, or ingested foreign bodies is usually related to gastrointestinal tract perforation.
- Medical conditions such as peptic ulcer disease or malignancy may be related to GIT perforation.
- History of medications such as nonsteroidal anti-inflammatory drugs or glucocorticoids.
Presentations of GIT perforation
- Acute symptoms associated with free perforation depend upon the nature and location of perforation:
Esophageal perforation
- Pharyngeal or neck pain: Pain radiating to the shoulder
- Odynophagia
- Dysphagia
Gastric or intestinal perforation
- A sudden release of the gastric acid into the abdomen causes severe and sudden peritoneal irritation and severe pain.
- Abdominal mass
- 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. Patients appear with hemodynamically unstablility or 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.