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Gastrointestinal (GI) Tract Perforation

Lee Surgery and Endoscopy was founded by Dr. Lee Chin Li, with the mission to deliver accessible and quality healthcare to our patients. We are committed to ensuring your comfort from consultation to procedures.

What is gastrointestinal (GI) tract perforation?

A gastrointestinal (GI) tract perforation is a serious medical condition in Singapore in which a hole forms in the hollow organs that make up your digestive system. These organs, which include your oesophagus, stomach, small intestine, and large intestine (also known as your bowel or colon), play crucial roles in moving food and liquids through your body. If a perforation occurs anywhere along this tract, it requires immediate medical attention due to the risk of leaking contents into your abdomen.

If you have a perforation in your large intestine, stool can leak into your abdomen, leading to peritonitis (inflammation of the inner abdominal wall lining) and sepsis. Given the critical nature of these potential outcomes, recognising the symptoms early and seeking immediate medical treatment is crucial to prevent severe complications associated with GI or bowel perforation.

What causes gastrointestinal (GI) tract perforation?

A variety of conditions can cause gastrointestinal (GI) tract perforation, each leading to this potentially life-threatening issue.

Some of the common causes of gastrointestinal tract tearing include:

  • Appendicitis: appendicitis is the inflammation of the appendix and can lead to gastrointestinal perforation if not treated promptly.
  • Diverticulitis: diverticulitis is an inflammation or infection of one or more diverticula, which are small pouches in the walls of the intestines. This condition often leads to gastrointestinal perforation. 
  • Hernias: hernias occur when an internal part of the body pushes through a weakness in the muscle or surrounding tissue wall; if the hernia becomes strangulated, it can cause gangrenous intestine and intestinal perforation.
  • Bowel obstruction: bowel obstruction can be caused by various conditions, including tumours, strictures, or foreign bodies. If not relieved, it may lead to increased pressure and, eventually, bowel wall perforation.
  • Inflammatory bowel disease (IBD): conditions like Crohn’s disease and ulcerative colitis are chronic inflammatory diseases of the GI tract that can lead to weakening and eventual perforation of the intestinal wall.
  • Peptic ulcer disease (PUD): ulcers in the stomach or duodenum can perforate through the stomach or small intestinal wall.
  • Forceful vomiting: forceful vomiting can lead to the rupture of the oesophagus, known as Boerhaave syndrome.
  • Volvulus: volvulus is a condition in which the bowel twists on itself, causing an obstruction that may lead to perforation.
  • Colon cancer: tumours of colon cancer can grow through the wall of the intestines, ulcerate and lead to perforation.
  • Trauma: this includes blunt trauma to the abdomen, knife or gunshot wounds, or complications from abdominal surgery.
twisted bowels singapore
Volvulus, where the intestine twists on itself, can lead to perforation.

What are the symptoms of gastrointestinal (GI) tract perforation?

The symptoms of gastrointestinal tract perforation vary depending on the cause and location of the perforation. General symptoms of GI tract perforation include:

  • Sudden and severe abdominal pain
  • Nausea and vomiting
  • Fever or increased body temperature
  • Changes in bowel habits (such as reduced frequency of bowel movements)
  • Fatigue
  • Shortness of breath
  • Rapid heartbeat
  • Distension
  • Abdominal tenderness upon touch
intestinal perforation singapore
Perforation of the large intestines can cause stool to leak into the abdomen, which can lead to other complications or conditions.

Is gastrointestinal (GI) tract perforation painful?

Yes, gastrointestinal tract perforation is painful. The pain typically starts at the perforation site before spreading throughout the abdomen. The severity of the pain and sudden onset are key signs that a serious issue, such as a perforation, may have occurred within your GI tract. If you are experiencing such symptoms, it is important to seek immediate medical attention.

Who is at risk of gastrointestinal (GI) tract perforation in Singapore?

Various factors could play a role in your risk of developing gastrointestinal (GI) tract perforation, such as:

How is gastrointestinal (GI) tract perforation diagnosed in Singapore?

Diagnosing GI tract perforation typically combines clinical assessment, imaging studies, and sometimes diagnostic procedures.

  • Clinical evaluation: the initial step in diagnosing a GI tract perforation involves a thorough medical history and physical examination by your specialist. During consultation, you may report symptoms of potential perforation, such as abdominal pain, chills, fever, nausea, vomiting, and signs of shock.
  • Imaging studies: X-rays and CT scans may be performed to aid the diagnosis process. An X-ray of the chest or abdomen is often performed as an initial imaging test, with the presence of free air in the pneumoperitoneum (abdominal cavity) as a sign of GI tract perforation. A CT scan provides more detailed images and can help identify the exact location and cause of the perforation.
  • Laboratory tests: blood tests, including complete blood count (CBC), electrolytes, and markers of inflammation, may be conducted to support the diagnosis by indicating infection or inflammation.
xray perforated bowel  
X-rays may be used to diagnose bowel perforation.

What are the treatment options for gastrointestinal (GI) tract perforation in Singapore?

Treatment options for gastrointestinal (GI) tract perforation in Singapore usually involves a combination of surgical intervention and management strategies to address both the immediate perforation and any underlying conditions and/or complications.

  • Surgical treatments:
    • Exploratory laparotomy/ diagnostic laparoscopy: exploratory laparotomy is an open surgical procedure in which an incision is made in the abdomen to identify the source of the perforation and repair it. Diagnostic laparoscopy utilises a few small cuts to use a laparoscopic camera and instruments to identify the site of perforation and also treat if possible. 
    • Omental patch: omental patch is a technique used particularly for small perforations. A piece of omentum (a layer of fatty tissue) patches the hole.
    • Resection: in cases where the perforation is due to a diseased section of the GI tract, a resection may be performed. This involves removing the affected segment and joining two healthy ends together surgically.
  • Antibiotics: antibiotic therapy is important in treating GI tract perforation to prevent or address infections caused by the leakage of intestinal contents into the sterile abdominal cavity. 
  • Intravenous (IV) fluids and haemodynamic management: initial management also involves establishing IV access for fluid resuscitation to treat or prevent shock and ensure adequate blood circulation.
  • Conservative care: non-surgical management may be considered in rare cases, especially if the perforation is small and contained. Conservative care methods may include antibiotics, bowel rest and close monitoring. 
  • Underlying condition management: addressing any underlying causes of the perforation is important to prevent recurrence and promote long-term health. 

Frequently asked questions

Does gastrointestinal (GI) tract perforation lead to complications?

If left untreated, GI tract perforation can result in serious complications such as widespread infection (peritonitis), sepsis, and shock, which can be life-threatening and hence require immediate medical attention.

Can I prevent gastrointestinal (GI) tract perforation?

While not all cases of GI tract perforation can be completely prevented, certain measures can help decrease your risk. These steps involve managing chronic conditions that impact your digestive system (such as Crohn's disease and ulcerative colitis) with appropriate medical care, avoiding excessive medication use (e.g., NSAIDs), promptly seeking treatment for abdominal infections like appendicitis, and upholding a healthy lifestyle to promote overall digestive well-being.

Are there any non-surgical treatments for gastrointestinal (GI) tract perforation?

Generally, non-surgical management of GI tract perforation is limited and not typically recommended. In carefully selected cases, small perforations resulting from peptic ulcers or diverticulitis may be addressed with antibiotics and close monitoring. Surgical intervention remains the primary method of addressing GI tract perforation to prevent complications.

How long does it take to recover from a gastrointestinal (GI) tract perforation surgery?

Your specialist will provide specific recovery timelines depending on your circumstances. The time needed to recover from surgery for a GI tract perforation can vary based on factors such as the severity of the perforation, your overall health, and any complications. Hospital stays typically range from a few days to several weeks, with complete recovery and a return to normal activities possibly taking weeks to months.

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