2023-11-09 18:45:00
Intestinal perforation is a serious medical condition that occurs suddenly and very quickly becomes life-threatening patients. It often requires surgery and hospitalization for several days. What exactly does it consist of? What symptoms should alert you? How to react to this medical-surgical emergency ? Answers from Dr Elise Pommaret, gastroenterologist and proctologist, member of the French National Society of Colo-Proctology (SNFCP).
Definition: what is an intestinal perforation?
As its name suggests, intestinal perforation refers to a hole in the intestine at any level of the digestive tract. “It’s a generic term that brings together very different situations, but all equally urgent,” explains the expert. It may in fact concern:
- the esophagus;
- the stomach;
- the small intestine (duodenum, jejunum or ileum);
- the large intestine (cecum, colon, rectum or anus).
Perforated intestine: the risk of sepsis!
“An intestinal breach or perforation allows bacteria, undigested food and feces to flow into the sterile abdominal cavity,” warns Dr. Pommaret. Main consequence of this phenomenon? The development of a infection du sang (sepsis) which can quickly lead to death by impairing heart, lung, brain and/or kidney function.
Symptoms: What are the signs of a perforation of the small intestine, stomach or colon?
Symptoms of intestinal perforation vary depending on its location and extent. They may in particular include:
- a severe, sudden pain in the abdominal region;
- from fever and chills in case of infection;
- of the intense nausea and vomiting ;
- of the bloating and an abdominal distension due to the presence of air and fluid in the abdominal cavity;
- and/or intestinal transit disorders(diarrhea or constipation).
At the slightest symptom, consult your doctor urgently or go to the emergency room!
What are the causes of intestinal perforation?
Many factors can cause intestinal perforation… And the causes of this perforation depend on its location, emphasizes Dr. Pommaret. Among the most common causes:
- voluntary or involuntary ingestion of a perforating foreign body (fish bones or chicken bones, even razor blades);
- various traumas linked to a road accident, a domestic accident, or even a criminal injury;
- ingestion of chemicalslike acid which can eat away at the mucous membrane and perforate it;
- a digestive infarction or certain pathologies, such as a very deep ulcer, a diverticulite, an intestinal obstruction, baddie crohn, a ulcerative colitiseven colon cancer (malignant tumors can indeed damage the intestinal wall);
- a complication during a surgical proceduresuch as a colonoscopy (iatrogenic perforation).
What are the risk factors?
Certain risk factors can indeed increase the likelihood of developing intestinal perforation. THE the elderly are notably more likely to suffer from diverticulitis, while people experiencing inflammatory bowel disease (IBD) are at increased risk due to chronic inflammation in their intestines.
The people having undergone abdominal surgery or suffering from malignant intestinal tumors also have a higher risk of intestinal perforation. Do not hesitate to consult a health professional to monitor your gut health and prevent possible complications (knowing that certain causes, such as accidents or the ingestion of foreign bodies that perforate the lining of the intestine cannot always be prevented).
Confirm the diagnosis before any intervention!
The doctor generally begins by asking you regarding your history, lifestyle habits and symptoms. He or she then performs a physical examination to check for swelling or stiffness unusual. He will also listen to your abdomen, because in the event of intestinal perforation, our stomach surprisingly no longer produces intestinal sounds.
Finally, to confirm the diagnosis and get an idea of the damage, he may prescribe: an emergency scannera x-ray of the chest and/or abdomenan upper digestive endoscopy or a colonoscopy, or even a CT scan (CT). Blood tests and complete blood count (FSC) may also be necessary to check for infection.
Treatment: how to treat intestinal perforation and restore digestive continuity?
Management of intestinal perforation depends on the cause and type of perforation, insists Dr Pommaret. In most cases, emergency surgery is necessary to repair the perforation and eliminate any infection present.
We start with stabilize patients, which may include pain management, blood pressure control, fluid management, and administering broad-spectrum IV antibiotics to prevent or treat infection. During the surgery, the practitioner repairs the perforation, removes any necrotic or infected tissue, cleans and drains the abdominal cavity to prevent future complications. “In some cases, it may be necessary to remove part of the damaged intestine and place a digestive stoma temporary before restoring digestive continuity,” explains Dr. Pommaret.
Immediately following surgery, patients are closely monitored in the recovery room. Antibiotic treatment is usually prescribed to prevent postoperative infection. There length of hospitalization and recovery period may vary depending on the severity of the perforation.
How does the postoperative follow-up take place?
Rehabilitation following intestinal perforation depends on the severity of the condition, the surgical procedure performed, and potential complications. In many cases, specific rehabilitation is not necessarybut some patients must follow specific measures…
Regular medical monitoring is necessary to monitor healing, assess any potential complications, and adjust treatment as needed. For example, some people must undergo functional rehabilitation, change their diet or provide special care to their wound in the event of a digestive ostomy.
And if you’ve experienced intestinal perforation due to an inflammatory disease, you may need to take anti-inflammatory medications and make some daily changes. In summary, everyone has their own rehabilitation!
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