Intestinal perforation

With a so-called Intestinal perforation or Intestinal perforation Doctors usually speak of an extremely serious clinical picture. Under certain circumstances, a ruptured bowel can develop into a life-threatening situation for those affected.

What is a perforated bowel?

An acute abdomen typically manifests itself as severe abdominal pain in the stomach or abdomen. This pain usually occurs suddenly and is very intense.
© Henrie - stock.adobe.com

In modern medicine, an intestinal breakthrough represents a local breakthrough in the intestinal wall. As a result, the contents of the intestine can penetrate unhindered into the abdominal cavity of the person affected. A perforated bowel can appear in different forms.

In modern medicine, for example, a fundamental distinction is made between a free intestinal perforation and a covered intestinal perforation. If the intestinal breakthrough is covered, those affected have a significantly higher chance of survival. It is not uncommon for neighboring organs to prevent the intestinal contents from penetrating the abdominal cavity.

causes

Different causes are responsible for the occurrence of an intestinal rupture. Basically, however, the causes cause a change in the structure of the intestinal wall.

For example, leading physicians cite inflammation of the intestine as a possible cause of an intestinal rupture. In most cases, this inflammation leads to a circulatory disorder in the area of ​​the intestinal wall. If there are harmful germs in the intestinal flora, the affected person will develop inflammation of the appendix. If left untreated, inflammation of the appendix can lead to a perforated bowel.

In addition to the causes already mentioned, external factors also favor the occurrence of an intestinal perforation. The so-called abdominal trauma plays an essential role here. If the body is exposed to extremely strong force, it can lead to serious injury to organs in the abdomen.

In addition to ulcers, however, the use of various sexual practices (e.g. anal intercourse with large objects) is also considered to be a cause of an intestinal rupture. Most patients have a dangerous rupture of the bowel even after acute constipation. Since the intestinal contents have not been removed for a long period of time, the volume within the intestine increases. The relatively thin wall of the intestine can often not withstand this load.

You can find your medication here

➔ Medicines for stomach ailments and pain

Symptoms, ailments & signs

An acute abdomen typically manifests itself as severe abdominal pain in the stomach or abdomen. This pain usually occurs suddenly and is very intense. The pain can spread throughout the abdomen and, in severe cases, affect the limbs.

Then there are cramps in the arms and legs, for example, which in turn are associated with discomfort and complications. An intestinal perforation can be recognized by the hardened abdominal wall. In addition, there is no bowel movement or it only takes place irregularly. The stool is usually bloody and dark red.

In most cases, the abdomen causes severe nausea and vomiting, but it can also be relatively symptom-free. A free intestinal perforation can result in peritonitis, which is associated with the typical fever symptoms. An acute abdomen is generally associated with severe discomfort.

Those affected feel sick and suffer from sweats, circulatory problems and fatigue. At the same time, serious failure symptoms can occur. In severe cases, a rupture of the bowel leads to a breakdown of the circulatory system and ultimately to death of the patient. For this reason, the symptoms mentioned must be clarified and treated immediately by an emergency doctor.

diagnosis

An intestinal rupture can be diagnosed by both the family doctor and the doctors in the hospital. As part of an initial examination, the person's abdomen is palpated. The abdominal wall is often extremely hard because the body builds up what is known as defensive tension.

At the same time, those affected complain of severe pain during the examination. In addition, imaging methods are generally used to diagnose an intestinal rupture. For example, an intestinal rupture can be diagnosed as part of an ultrasound examination.

If the X-ray is used as a method to diagnose an intestinal rupture, the person concerned must stand during the examination. This is the only way to correctly diagnose any air that may be present in the area of ​​the diaphragm. For medical professionals, air in the area of ​​the diaphragm is a clear sign of an intestinal rupture.

Complications

A rupture of the intestine is in any case a condition that requires treatment. In order to keep serious complications as low as possible, the patient must seek medical treatment immediately if an intestinal rupture is suspected. Colon perforations must be treated surgically. Possible complications therefore also arise from the type of therapy.

In less complicated cases, the patient can leave the hospital after a relatively short period of time. In order to avoid consequential damage, it is important to take sufficient care of yourself. Otherwise there is a risk of the organ breaking through again. Complications are more likely to occur with major intestinal injuries than with minor ones.

Existing underlying diseases can also increase the risk of complications. Another potential problem is infection of the wound. There is also the risk that the patient will develop what is known as peritonitis. Peritonitis occurs when the bacteria migrate from the injured intestine via the blood to the abdominal cavity.

As a result of this inflammation, dehydration and low blood pressure are other problems that can occur. In combination, this can lead to circulatory shock. If the bacteria enter the bloodstream, the risk of sepsis increases, which can be life-threatening.

When should you go to the doctor?

The breakthrough of the intestine is a life-threatening and acute condition for those affected. For this reason, a doctor should be consulted as soon as possible in the event of discrepancies. Persistent complaints during the digestive process or in the region of the abdomen must be examined and treated by a doctor. If the symptoms increase in intensity or if they spread further into the lower abdomen, a doctor is needed.

Pain, bleeding or a change in bowel movements are considered unusual and should be investigated. If you have a fever, constipation, vomiting or diarrhea, you should see a doctor. If pus emerges from the anus, swelling of the skin and general malaise occur, it is advisable to consult a doctor. A doctor is needed if you feel pressure in the abdomen, if your general performance limit has dropped, pain in movement or an inner restlessness.

As soon as the symptoms persist for several days and there is no apparent reason, due to psychological stress or an unhealthy food intake, a consultation with a doctor is necessary. If there are disorders of consciousness or if the person concerned can suddenly no longer move without assistance, an emergency doctor is required. First aid measures are to be carried out until it arrives. Before taking any medication, it is essential to consult a doctor.

Doctors & therapists in your area

Treatment & Therapy

A rupture of the intestine generally requires rapid treatment. Since an intestinal rupture is a life-threatening situation for those affected, surgery must always be performed. The affected area is closed during the operation.

If the contents of the intestine have penetrated the abdomen, those affected are also treated with a so-called antibiotic. In addition, intensive medical monitoring for a period of around 10 days is essential. The administration of the antibiotic is supposed to kill dangerous germs. This is the only way to prevent life-threatening inflammation.

If the acute intestinal breakthrough is due to cancer, in most cases part of the intestine is removed. This is the only way to prevent metastases from forming in other areas of the body. An artificial anus is often placed as part of this therapy.

Outlook & forecast

A ruptured bowel can lead to a life-threatening condition without prompt medical care. Organ failure threatens the death of the person concerned. In emergency treatment and surgery, the patient must be stabilized as quickly as possible so that survival is ensured.

If intensive medical treatment succeeds in closing the affected area immediately and properly, there is a good prognosis and a good chance of recovery. The patient can be discharged from treatment after a few weeks as symptom-free. In the further course, rest and overexertion must be avoided. However, everyday obligations can be met as usual. In addition to rapid treatment, the underlying disease is largely responsible for the prospect of recovery.

If there is an intestinal defect, it must be clarified whether it is a regenerative or chronic disease. If the intestinal contents have distributed through the intestinal perforation in the abdominal cavity, a subsequent drug treatment is required. Germs must be fought and killed so that no inflammation or sepsis occur.

If blood poisoning occurs, the patient is also in a life-threatening condition. If other secondary diseases occur, the healing process is delayed by a few weeks or months. However, recovery is possible with good treatment and occurs in most patients.

You can find your medication here

➔ Medicines for stomach ailments and pain

prevention

A rupture of the intestine can be effectively prevented, among other things, by eating foods rich in fiber. The fiber contributes significantly to a healthy intestinal flora. In addition, digestion is stimulated by the intake of fiber. A possible blockage can thus be actively prevented. In most cases, it is responsible for the occurrence of an intestinal perforation.

Aftercare

Follow-up care for an intestinal perforation depends entirely on the underlying cause. If the breakthrough was triggered by a cancer, the treating doctors in the emergency operation have most likely removed ulcers, tumors and possibly even part of the intestine. In these cases, follow-up care consists of regular check-ups with colonoscopy, laboratory checks and ultrasound checks, as well as keeping appointments for radiation or chemotherapy.

For all other causes of the disease, treatment of the underlying disease is usually sufficient, in which the person affected should strictly adhere to the doctor's instructions. In any case, the patient must take antibiotics postoperatively, as this kills dangerous germs and prevents inflammation of the surrounding organs. For this purpose, those affected are initially monitored by an inpatient intensive care unit for up to ten days in order to be able to react quickly to any complications.

The intestinal perforation itself does not require any further follow-up care after a final check by the doctor. If complications occur in the form of wound healing disorders, infections, bruises, secondary bleeding or, in the worst case, an intestinal obstruction, which are mainly caused by the underlying diseases, the attending physician must be consulted immediately.

Switching to a healthy, high-fiber diet helps prevent intestinal perforation from occurring again. This keeps the intestine active, ensures a healthy intestinal flora and prevents blockages which could damage the intestinal wall.

You can do that yourself

A ruptured bowel is an acute illness that requires immediate treatment by an emergency doctor. At the same time, the first aiders should take first aid measures and, for example, bring the person affected into a stable lateral position.

After the treatment, strict bed rest applies to those affected. The doctor will also prescribe dietary measures and arrange further examinations. In this way the acute symptoms can be alleviated and a new intestinal perforation reliably prevented. Alternative remedies can be used with the doctor's approval.

Aniseed, gentian or fennel, which can be used in the form of teas, toppings or warm baths, have proven effective for intestinal problems. Homeopathic remedies such as Schüßler salts or healing earth can also be tried after consulting the responsible doctor.

If the course is severe, however, therapeutic measures are useful. If, for example, the rupture of the intestine makes you bedridden, a specialist can help you accept the new circumstances. Visiting a self-help group for chronic intestinal diseases is an important step for many people affected. It is best to discuss with the family doctor which specific measures are possible and which are covered by the health insurance.