Sepsis and 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 can spill into your abdomen and cause peritonitis, an infection. Such an infection can lead to sepsis. Sepsis 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.

Suggested Citation:
Sepsis Alliance. Sepsis and Perforated Bowel. 2024.

Updated March 14, 2024.


More About 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 & Symptoms

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 & Treatment

A perforation anywhere in the GI tract is a medical emergency. The emergency medicine 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.


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.

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Susan H.

The Day I went missing. November 24, 2020 was the last day before Thanksgiving Break from high school. I am a 62 yr. old female, entering my 18th year of teaching special education. I had a history of diverticulosis, my father died when I was 18 of colon cancer. I was consistent with preventive colon care, but had been hospitalized for a night for diverticulitis in 2019. After the infection had cleared, a colonoscopy revealed severe diverticulosis, and gastro doctor advised 11 inches be taken out. My husband and I both met with him and got a second opinion, and ... Read Full Story

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Margaret Foster

My mother died of sepsis on Tuesday, February 13, 2024, at the age of 73. She had a history of diverticulitis, but was told after her routine colonoscopy in 2023 that although she had diverticulitis throughout her colon, that she could either schedule a colonoscopy in 10 years, or she could choose to never have one again. On the morning, of February 13, my mother called me and said she was in terrible pain and needed to go to the hospital. I rushed to her home, saw that she had a high fever, called 911, and she was at the ... Read Full Story

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Gail Guglietta

My wife, Gail Guglietta died from septic shock in March 2020. She was 54 years old, having just celebrated her birthday the previous December. The sepsis was brought on by a ruptured colon, which was caused by undiagnosed diverticulitis. (Sepsis and Perforated Bowel, Sepsis and Septic Shock) Despite living a healthy lifestyle that included being active, eating and cooking healthy (she was an excellent cook), and exercising regularly, she dealt with digestive system issues her whole life. It caused her to downplay these problems, noting that these problems happened to her grandmothers. With that, she never got the right diagnosis ... Read Full Story

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James Schmidt

My name is James. I am a 53 year old male who lives in Minneapolis, MN. On May 10th of 2021 I woke up and was getting ready to go to the clinic I work at when I started experiencing some abdominal discomfort. Within a half hour I was doubled up in the fetal position in the worst pain ever. EMT to the hospital where I was informed I had a perforated bowel w/ fecal peritonitis. (Sepsis and Perforated Bowel) Went into emergency surgery as well as septic shock and barely survived. Woke up with a colostomy bag and was ... Read Full Story

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Tina Otten

My Story: (I wrote this for my online, private support group. Thought I’d share here also. Not looking for sympathy just wanted to share. There’s always hope in your life) Flashback July 2014: I didn’t even know what a colostomy was !! I had severe diverticulitis and had numerous episodes where my bowel perforated (unbeknownst to me !!??!!) Although I was informed before the surgery there might be a chance I could end up with a bag, I never imagined I would be the unlucky one it could happen to. Not knowing was probably better in hindsight. I came round ... Read Full Story

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Perforated Bowel