A perforated bowel, or intestinal perforation, occurs when a hole forms in the wall of the small intestine or colon (large intestine). This allows the bowel’s contents to leak into the abdominal cavity. Common symptoms include sudden, intense abdominal pain, nausea, vomiting, and fever. 

Abdominal injuries, infections, or chronic illnesses like inflammatory bowel disease (IBD) can cause bowel perforation. Other causes include a loss of blood flow to the intestines or blockages, such as impacted stool or tumors, which put pressure on the bowel wall. 

A perforated bowel is a medical emergency that requires immediate surgery. Without treatment, it can cause severe infections, including sepsis, a life-threatening response to infection.

Healthcare providers classify bowel perforation types based on the location of the hole in the intestinal wall.

Bowel perforation can occur in the small or large intestine (colon). Because the small and large intestines have different structures and functions, the location of the perforation helps healthcare providers determine the underlying cause and appropriate treatment. 

Small Intestine Perforation

The small intestine absorbs water and nutrients from the foods you eat and moves digestive waste into the large intestine.

Small intestine perforations are rare, affecting 1 in 350,000 people each year. The most common causes include medical procedures (such as abdominal surgery), injuries, infections, and diverticulitis (inflammation or infection of abnormal pouches in the intestine). 

Large Intestine (Colon) Perforation

The large intestine processes digestive waste, consisting of undigested food, fluids, and old cells from the gastrointestinal tract lining. It absorbs water and transforms this waste into solid stool. Muscular movements push the stool toward the rectum for elimination.

Bowel obstruction (such as impacted stool), diverticulitis, and IBD (Crohn’s disease or ulcerative colitis) are the most common causes of colon perforations.

Trauma or injury to the large intestine during medical procedures, such as a colonoscopy, can also cause perforations.

A perforated bowel causes sudden and severe abdominal pain. People with an underlying gastrointestinal condition or bowel obstruction may experience worsening symptoms leading up to the perforation, including: 

• Abdominal discomfort
• Bloating
• Nausea
• Loss of appetite 
• Difficulty passing gas or having a bowel movement 

Once a perforation occurs, symptoms develop suddenly and escalate quickly. These symptoms may include: 

• Severe abdominal pain that comes on suddenly and doesn’t go away
• Fever or chills
• Nausea and vomiting
• Abdominal swelling or tenderness
• Inability to pass gas or stool 

A perforated bowel occurs when a hole forms in the inner wall of the large or small intestine, allowing its contents to leak into the abdominal cavity. This leakage can lead to severe infection, such as peritonitis (inflammation of the lining of the abdominal cavity), and can quickly become life-threatening.

Underlying conditions that weaken or inflame the intestinal wall can cause a perforated bowel. These include:

• Diverticulitis (inflammation or infection of abnormal pouches in the intestine)
• Appendicitis (inflammation of the appendix, a pouch on the colon)
• Inflammatory bowel disease (IBD), including Crohn’s disease and ulcerative colitis 
• Toxic megacolon (rare but life-threatening inflammation and swelling of the colon)
• Bowel impaction (impacted stool or from swallowing non-food items) 
• Colon cancer

A perforation can also happen due to physical trauma to the abdomen from an accident or medical procedure, such as: 

• Abdominal surgery if the surgeon accidentally damages the intestine 
• Stitches or staples coming undone following bowel surgery 
• Colonoscopy 
• Blunt force trauma to the abdomen, such as during a car accident or fall 
• Knife or gunshot wound 

A lack of blood flow or poor blood flow to the intestines could also lead to perforation. Reduced blood flow can occur due to a strangulated hernia (when tissue pushes through a weak muscle wall and becomes trapped, cutting off blood supply) or blockages (such as blood clots) in an artery that supplies blood flow to the intestines.

Risk Factors

Anyone can experience a perforated bowel, though certain factors can increase the risk, including:

• Age: Older adults are at higher risk of bowel perforation due to age-related changes in the gastrointestinal system, such as weakened intestine tissues.
• Lifestyle: Smoking and eating a diet low in fiber increase the risk of diverticulitis, a leading cause of bowel perforations.
• Underlying conditions: Diverticulitis and IBD make the bowel more vulnerable to perforation. Conditions affecting blood flow to the intestines, such as diabetes or a history of blood clots, can also increase the risk.
• Certain medications: Long-term use of nonsteroidal anti-inflammatory drugs (NSAIDs), glucocorticoids (steroid hormones), and some cancer treatments (such as chemotherapy drugs) can increase the risk of bowel perforation. 

The goal of diagnosing a perforated bowel is to confirm the diagnosis quickly so treatment can begin as soon as possible to avoid serious complications.

Your healthcare provider will ask about your symptoms and review your medical history. They will then perform a physical examination, checking for abdominal tenderness and swelling. They will also check for fever and rapid heart rate, which are signs of peritonitis (abdominal infection). 

Diagnostic tests can help confirm the diagnosis and identify the location and severity of the bowel perforation. Your healthcare provider may order: 

• X-rays: X-ray images can help identify air within the abdominal cavity, a sign of intestinal perforation. 
• Computed tomography (CT) scan: This imaging test takes detailed pictures of the internal organs within the abdomen, including the small and large intestines. It can confirm the diagnosis and assess the location and severity of the perforation.
• Blood tests: Taking blood samples can help detect signs of infection, such as an elevated white blood cell count. Blood tests can also measure red blood cell count to diagnose anemia, a sign of internal bleeding from the perforation. 

A perforated bowel is a medical emergency that requires prompt medical attention and immediate treatment to prevent life-threatening complications. Treatment goals include repairing the hole in the intestinal wall and preventing or treating infection.

Surgery

Most perforated bowels require immediate surgery to repair the hole. If the perforation is small, healthcare providers may take a “watch and wait” approach to see if the hole will repair itself, but this is rare.

In most cases, surgery takes place shortly after diagnosis. Healthcare providers may perform the surgery laparoscopically. This involves making small incisions in the abdomen and, using a small camera, inserting surgical tools through the incisions to repair the hole and drain any intestinal contents within the abdominal cavity. 

In some cases, the surgeon may need to remove damaged portions of the intestine and create a colostomy or ileostomy. This procedure involves forming a stoma, or opening, in the abdomen through which waste is diverted into an external bag. Bypassing the normal digestive route helps protect the healing bowel.

A colostomy or ileostomy can be temporary, giving the intestines time to heal. A second surgery can help reconnect the bowel and remove the stoma. Extensive bowel damage may require a permanent stoma for waste elimination.

Antibiotics

Your healthcare provider will prescribe broad-spectrum antibiotics to prevent or treat infections that develop when intestinal contents leak into the abdominal cavity. You may receive these intravenously (IV) before and after surgery to eliminate the infection or reduce the risk of one developing.

Supportive Care

After surgery, you will remain in the hospital to recover and receive supportive care to promote healing. This may include:

• Nutritional support: Rather than eating by mouth, you may need a nasogastric tube (a tube that goes through your nose and down to your stomach) to deliver nutrients while your bowel heals. 
• Fluids: Intravenous fluids delivered through a tube into a vein can help provide hydration while you heal. 

It’s not always possible to prevent a perforated bowel, but many people experience abdominal pain for several days before an intestinal perforation develops. If you notice persistent abdominal discomfort, schedule an appointment with your healthcare provider as soon as possible. Treating the underlying cause may help prevent a perforation before it occurs. 

If you have certain risk factors, such as IBD, diverticulitis, or chronic constipation, certain lifestyle habits may help lower your risk of bowel perforation: 

• Routine screenings: Regular colonoscopies can detect conditions that can cause bowel perforation, like diverticulitis or colorectal cancer, early.
• Manage underlying conditions: Following your treatment plan for underlying conditions like IBD may lower your risk of perforation.
• Increasing fiber intake: Eating a fiber-rich diet with fruits, vegetables, and whole grains can support healthy bowel habits and lower the risk of constipation, which can sometimes cause bowel obstruction and perforation.

A perforated bowel is a medical emergency and requires prompt medical treatment to prevent complications. Possible complications include: 

• Peritonitis: An infection that develops when the intestinal contents spill into the abdominal cavity, leading to severe inflammation.
• Sepsis: A systemic (bodywide) response to infection that occurs when bacteria from the bowel perforation enter the bloodstream. It causes extreme pain, fever, chills, high heart rate or weakened pulse, and confusion or disorientation. Left untreated, sepsis is life-threatening. 
• Abscess formation: Localized pockets of pus that can form in the abdominal cavity due to infection, which may require surgical drainage to remove. 
• Multi-organ failure: Untreated infection can damage organs in the abdomen, causing them to shut down. Without prompt treatment, multi-organ failure is often fatal.

A perforated bowel is a serious medical emergency that occurs when a hole forms in the intestinal wall, allowing contents to leak into the abdomen.

Symptoms include sudden and severe abdominal pain, nausea, and vomiting. If the intestinal contents leak into the abdominal cavity and cause infection, a fever can develop.

Prompt surgery to repair the hole in the intestinal wall is the most common treatment for a perforated bowel. Left untreated, bowel perforation can lead to life-threatening complications, including sepsis and organ failure.