Perforated Bowel

A perforated bowel occurs when hole develops in your bowel wall, part of your gastrointestinal (GI) tract. The GI tract runs from your throat to your rectum. Food travels down your esophagus, into your stomach, where it empties into your small intestine, and then into your large intestine, or bowel. If the perforation occurs in your bowel, it may be called a perforated bowel.

If your GI tract is perforated, the contents may spill into your abdomen and cause peritonitis, an infection. Such an infection can lead to sepsis. Sepsis, which was often called blood poisoning, is a life-threatening emergency that happens when your body’s response to an infection damages vital organs and, often, causes death. Like strokes or heart attacks, sepsis is a medical emergency that requires rapid diagnosis and treatment.

Sepsis and septic shock can result from an infection anywhere in the body, such as pneumonia, influenza, or urinary tract infections. Worldwide, one-third of people who develop sepsis die. Many who do survive are left with life-changing effects, such as post-traumatic stress disorder (PTSD), chronic pain and fatigue,  organ dysfunction (organs don’t work properly), and/or amputations.

How do you get a perforated bowel?

Your GI tract can perforate because of a GI-related condition or disease, or from a trauma. Conditions that may cause a perforation include:

  • Diverticulitis
  • Ulcerative colitis or Crohn’s disease
  • Toxic megacolon
  • Strangulated hernia, which can result in poor blood flow to the intestines
  • Injury from a medical procedure, such as a colonoscopy or surgery
  • Peptic ulcer disease
  • Forceful vomiting
  • Loss of blood or poor blood flow to the intestine caused by a blockage in the artery

The most common trauma that causes a perforated bowel occurs during abdominal surgery, when the surgeon may accidentally nick or cut the bowel and not notice it. Occasionally, a rupture or perforation may happen following bowel surgery, because the stitches or staples used to close the bowel come undone.

Other less common causes for a perforation include:

  • Knife or gunshot wound
  • Severe blow to the abdomen
  • Damage caused by swallowed foreign objects
  • Damage caused by swallowing a corrosive (caustic) substance
  • Appendicitis

Signs and symptoms of a perforated bowel

The signs and symptoms of a perforated GI tract come on gradually, getting worse, although they might not be too noticeable at first. They may include:

  • Severe stomach pain
  • Chills
  • Fever
  • Nausea
  • Vomiting

Diagnosis and treatment

A perforation anywhere in the GI tract is a medical emergency. The emergency room doctor will order x-rays and perhaps a computed tomography scan (CT scan). Blood tests look for signs of infection and blood loss from the perforation.

Surgery is usually performed to repair a GI perforation, particularly if it is in the bowel. Rarely, the doctor may prefer to take a wait-and-see approach, to see if the hole will repair itself. Meanwhile, the sepsis caused by the infection must be treated quickly with antibiotics and fluids.

In some cases, the surgeon must perform a colostomy or ileostomy. This surgery allows the contents of your intestines to empty into a bag, through a stoma, a hole created in your abdomen. The colostomy or ileostomy may be temporary, allowing the rest of your intestines to heal. You would then go for a second surgery so your surgeon can reattach your intestines, so you no longer need to eliminate your waste through the stoma. In other cases, the surgery is permanent.

In addition to surgery to repair the perforation, you will likely receive intravenous (IV) antibiotics to either prevent an infection from occurring or to treat one that has started.

Prognosis

A GI perforation is a medical emergency and requires quick recognition of the signs and symptoms, and rapid medical response. When this occurs, recovery should be complete.

If you suspect sepsis, call 9-1-1 or go to a hospital and tell your medical professional, “I AM CONCERNED ABOUT SEPSIS.” 

Would you like to share your story about sepsis or read about others who have had sepsis? Please visit Faces of Sepsis, where you will find hundreds of stories from survivors and tributes to those who died from sepsis.

Suggested Citation: Sepsis Alliance. Sepsis and Perforated Bowel. 2023. https://www.sepsis.org/sepsisand/perforated-bowel/

Updated Aug. 4, 2023.

Read Personal Stories of Sepsis and Perforated Bowel

Deborah Olson

Survivor

My sepsis story is from over 10 years ago and the reason I’m deciding today to share this is because my life has never been the same since recovering from sepsis! I continue to have extremely brutal health challenges, including two types of cancer, bowel and bladder issues and continuing G.I. issues! Unfortunately, my health challenges since having perforated diverticular in 2014, that led to sepsis, 21 days and the hospital with four days in ICU and them bringing me back once. (Sepsis and Perforated Bowel) When I finally got out of there, I had a wound pump, a PICC ... Read Full Story

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Michael Mark

Survivor, Tribute

My father was diagnosed in October with having a weak heart. For the next 4 months he was admitted into the hospital every month for at least one week. The end of January, I walked into my father’s room finding him laying there but his face was blue. I called 911 and he was rushed to the hospital. He was initially diagnosed with pneumonia, then viral pneumonia, then sepsis. (Sepsis and Pneumonia) With a surprise, his heart function went from 40% back to 90%. He did recover from sepsis while in the hospital. The doctors stopped his IVs. He was ... Read Full Story

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Elinor Goldie

Survivor, Tribute, Survivor

First time 2007, bowel perforation, and two days lying in hospital as new year lack of staff. (Sepsis and Perforated Bowel) Scan two days later, hole in bowel.Emergency surgery and colostomy and woke up days later intensive care: sepsis and would be lucky to survive night. Family called. I did survive but kidneys and organs took bashing. Unwell, PTSD, I was terrified and still constipated. 2014 Ileostomy op and okay at first but off and on infections, dental and upper airways but no one mentioned sepsis. Pain ,nausea and more infections. They found gallstones but said they were fine. My ... Read Full Story

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Deborah Jay

Survivor, Tribute, Survivor, Survivor

I had a hysterectomy and my bowel perforated. (Sepsis and Surgery, Sepsis and Perforated Bowel) I developed an enterocutaneous fistula which means there was an abnormal connection between my small intestine and my skin. When they tried to repair it I became very Ill, I literally felt death was the preferred option as I could feel my body and mind shutting down. I was in hospital but they weren’t concerned. Two days later my lungs collapsed, I had respiratory failure and nearly died. They found I had intra abdominal sepsis owing to a leak in the bowel, I’ve never fully ... Read Full Story

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Shawnise Chantell

Survivor, Tribute, Survivor, Survivor, Survivor

2019. After a peaceful beautiful birth of my third child, I opted in for a tubal ligation. I understood that the procedure was simple and harmless. The doctor was immediately ready for surgery so I didn’t get to bond with my baby and breastfeed. Immediately after surgery I declined. I constantly voiced severe abdominal pain, showed signs of fever, low blood pressure, fatigue and fainting, as well as my refusal to eat. However all signs were ignored. During surgery the doctor perforated my bowel and it was left untreated for 6 days. (Sepsis and Perforated Bowel) I remained hospitalized for ... Read Full Story

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Perforated Bowel

A perforated bowel occurs when hole develops in your bowel wall, part of your gastrointestinal (GI) tract. The GI tract runs from your throat to your rectum. Food travels down your esophagus, into your stomach, where it empties into your small intestine, and then into your large intestine, or bowel. If the perforation occurs in your bowel, it may be called a perforated bowel.