Gastrointestinal perforation (GP) occurs when a hole forms all the way through the stomach, large bowel, or small intestine. It can be caused by several different conditions, such as appendicitis and diverticulitis. In most cases, surgery is needed to close the hole.

Doctor examining a person's abdomen area. Share on Pinterest
Kar-Tr/Getty Images

Gastrointestinal perforation (GP), or intestinal perforation, is where a hole develops in your gastrointestinal (GI) tract. While it can be caused by several health conditions, it can also result from trauma, such as a knife or gunshot wound.

A hole in your gastrointestinal system can lead to peritonitis, an inflammation of the membrane that lines the abdominal cavity.

Peritonitis can occur when any of the following enters the abdominal cavity:

  • bacteria
  • bile
  • stomach acid
  • partially digested food
  • stool

GP is a medical emergency that requires immediate medical treatment. The condition is life threatening and chances of recovery improve with early diagnosis and treatment.

Symptoms of GP may include:

If you’ve had a gastrointestinal perforation and peritonitis occurs, the abdomen may feel painful and tender. This can often worsen if someone touches the area or when you move. The abdomen may also stick outward more than what is usual for you and feel hard.

There are many possible causes of GP, including health conditions such as:

GP can also be caused by external factors such as:

  • blunt trauma to the abdomen
  • a knife or gunshot wound to the abdomen
  • abdominal surgery
  • ingestion of foreign objects or caustic substances, which are chemicals that can cause severe burns when ingested

Rarely, the condition may occur due to bowel injuries from an endoscopy or colonoscopy.

To diagnose GP, a doctor will typically take X-rays of your chest or abdomen to check for air in the abdominal cavity. They may also perform a CT scanto get a better idea of where the perforation might be.

Alongside these tests, they will order lab work to:

In most cases, surgery is necessary to repair the hole and treat the condition. The goals of surgery are to:

  • fix the anatomical problem
  • fix the cause of peritonitis
  • remove any foreign material in the abdominal cavity that might cause problems, such as feces, bile, and food

In rare cases, a doctor may forgo surgery and only prescribe antibiotics if the hole has closed on its own.

Sometimes, a piece of the intestine will need to be removed. The removal of a portion of either the small or large intestine may result in a colostomy or ileostomy, which allows intestinal contents to drain or empty into a bag attached to your abdominal wall.

GP can lead to complications if it is left untreated or, in rare cases, as a result of a treatment method.

Complications associated with GP include:

In some cases, GP can be fatal.

Wound failure may also occur. This is where the wound can’t or doesn’t heal. Factors that increase the risk of this include:

  • malnutrition, or poor diet
  • smoking
  • infection
  • presence of necrotic tissue, the death of cells in the tissue
  • type 2 diabetes
  • ischemia, reduced bloow flow
  • poor hygiene
  • glucocorticoid use,
  • radiation exposure

Certain anti-inflammatory drugs that suppress the immune system, such as steroids or corticosteroids, can also result in complications, by masking an ongoing infection and delaying diagnosis.

The success of surgery to repair a perforation depends on the size of the hole and the length of time before treatment. Factors that can hinder treatment include:

  • advanced age
  • existing bowel disease
  • bleeding complications
  • malnutrition
  • the nature of the original cause
  • smoking
  • active treatment for cancer
  • conditions requiring steroids or biologic agents, such as lupus or rheumatoid arthritis
  • other medical conditions such as heart disease, kidney or liver problems, and emphysema

If you experience pain or fever and believe you’re at risk of having a GP, you should seek medical attention immediately. The sooner you begin treatment, the better your outlook will be.

Preventing gastrointestinal perforation

There are many causes of GP. For example, an underlying gastrointestinal disease can increase your risk for perforation. This is why it can be beneficial to learn more about your medical history and seek information on current conditions that can increase your risk.

Was this helpful?

Can gastrointestinal perforation heal on its own?

In rare cases, gastrointestinal perforation can heal on its own and not require surgery. In this instance, a doctor will typically prescribe antibiotics to clear up any infections.

Could you have a perforated stomach and not know?

In rare cases, it is possible to have a perforated stomach and not know. As the condition causes abdominal pain and tenderness, some people may mistakenly associate their symptoms with another condition that results in similar symptoms, like appendicitis.

What is the survival rate of a gastrointestinal perforation?

The survival rate of gastrointestinal perforation is around 50 to 70%. The risk of mortality can increase the longer treatment is delayed. Chances of recovery can improve with an early diagnosis and treatment.

Gastrointestinal perforation (GP), or intestinal perforation, occurs when a hole forms all the way through the stomach, large bowel, or small intestine. It can be caused by a health condition, such as inflammatory bowel disease (IBD), or from the result of trauma to the body, such as a knife or gunshot wound.

To diagnose GP, a doctor will take X-rays of your chest or abdomen. If a positive diagnosis occurs, surgery will most likely be needed to repair the hole and treat the condition.

If you experience any significant change from your usual state, especially if you have abdominal pain and fever, consider speaking with a doctor. Chances of recovery from GP improve with early diagnosis and treatment.