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Intestinal obstruction with Perforation.

This video shows Intestinal obstruction with Perforation. Intestinal perforation, defined as a loss of continuity of the bowel wall, is a potentially devastating complication that may result from a variety of disease processes. Common causes of perforation include trauma, instrumentation, inflammation, infection, malignancy, ischemia, and obstruction. The classic presentation is sudden and severe abdominal pain, sometimes with localized peritonism or a rigid abdomen on examination. Gastrointestinal perforation (GP) occurs when a hole forms all the way through the stomach, large bowel, or small intestine. It can be due to several different diseases, including appendicitis and diverticulitis. It can also be the result of trauma, such as a knife wound or gunshot wound. Sonography is also able to detect primary ascaridial perforation as two pairs of parallel lines, representing the worm's outer margins, flanking a central sonolucent line, representing its digestive tract. It could be found also in the peritoneal cavity and in some loops of the small bowel. To diagnose the condition, the doctor may carry out one or more of the following tests: 1). X-ray of the chest and abdomen. This is to check for air in the abdominal cavity, a sign of gastrointestinal perforation. 2). CT scan. This helps the doctor to locate any possible holes. 3). Blood test. If your GI tract is perforated, the contents may spill into your abdomen and cause peritonitis, an infection. Such an infection can lead to sepsis. Sometimes incorrectly called blood poisoning, sepsis is the body's often deadly response to infection. A perforated bowel is a medical emergency. Left untreated, it can quickly lead to sepsis, organ failure, shock, and even death. Intestinal perforation is a significant life-threatening condition with high morbidity and mortality that requires emergency surgery. Despite improvements in surgical and medical treatments, the overall mortality rate is 30%, and the mortality rate of cases that also have diffuse peritonitis is up to 70%. Bowel perforations occur when a hole is made in this lining, often due to colon surgery or severe bowel disease. A hole in the colon then allows the contents of the colon to leak into the usually sterile contents of your abdominal cavity. In more severe diverticulitis, when perforation or an abscess is suspected, you may experience significant abdominal pain, an inability to tolerate food, constipation, or fever and chills. Bowel perforation is an acute surgical emergency where there is a release of gastric or intestinal contents into the peritoneal space. The primary symptoms of gastrointestinal perforation are severe abdominal pain and tenderness. The abdomen may also protrude or feel hard to the touch. If the hole is in a person's stomach or small intestine, the onset of pain is usually sudden, but if the hole is in the large bowel, the pain may come on gradually. Constipation and fecal impaction can frequently be seen especially in elderly and debilitated patients. On the other hand, fecalomas rarely can cause colonic ischemia and stercoral perforation. Mainly older, weak, and bedridden patients are affected. The main trigger reason is chronic constipation. History of Intestinal Perforation Severe and generalized abdominal pain (upper) Gradual and localized pain (lower) Anorexia, nausea, and vomiting. Examination of Intestinal Perforation Rigid abdomen and generalized tenderness Guarding and rebound Bowel sounds range from quiet to absent Pathophysiology of Intestinal Perforation Gastric and duodenal ulceration Infection (diverticulitis, appendicitis), ischemia, and cancer Blunt and penetrating trauma Ingestion of corrosive materials Iatrogenic causes (ERCP, colonoscopy, laparotomy, biopsy) Role of Imaging in Intestinal Perforation If perforation is suspected then an erect chest X-ray should be performed as well as an abdominal X-ray. This image shows a very large volume of gas under the diaphragm due to bowel perforation. Gastrointestinal perforation (GP) occurs when a hole forms all the way through the stomach, large bowel, or small intestine. It can be due to several different diseases, including appendicitis and diverticulitis. It can also result from trauma, such as a knife wound or gunshot wound. Treatment most often involves emergency surgery to repair the hole. Sometimes, a small part of the intestine must be removed. One end of the intestine may be brought out through an opening (stoma) made in the abdominal wall. ... A drain from the abdomen or other organs may also be needed. Carefully selected patients with small bowel perforated diverticulitis can be successfully treated with IV antibiotics, bowel rest, and serial abdominal exams.