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. Sometimes incorrectly called blood poisoning, sepsis is the body’s life-threatening response to infection. 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
  • Crohn’s disease
  • Toxic megacolon
  • Strangulated hernia, which can result in poor blood flow to the intestines
  • 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. 2022. https://www.sepsis.org/sepsisand/perforated-bowel/

Updated May 3, 2022.

Read Personal Stories of Sepsis and Perforated Bowel

Debra Aplin

Survivor

I had my gallbladder removed in November 2020, I woke up screaming in pain my bowel had been perforated during surgery and sepsis was setting in. (Sepsis and Perforated Bowel, Sepsis and Surgery) I was taken back to theatre that night but the tear was not found my intestines were washed out, the next day I deteriorated so was taken back to theatre again where the tear was finally found in my small bowel and repaired. I knew nothing of the two operations until I awoke in a different hospital in ICU on a ventilator completely traumatised. I was terrified ... Read Full Story

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Teresa Davis

Survivor, Survivor

In October of 2016 I had a non cancerous ovarian mass removed. In doing so, my doctor clipped my bowel. (Sepsis and Perforated Bowel) I was sewn up, no drains and stayed in the hospital a week before they let me go home. Within two weeks of being home, I couldn’t eat, had no energy, was nauseous, and could not breath if I attempted to lie back. They had me come in right away for a CT. From that point I was given a sedation (during the CT), and sent to emergency surgery. The bowel had been leaking content into ... Read Full Story

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Kelly A.

Survivor, Survivor, Tribute

My daughter passed away in February 2022. She passed because of sepsis caused by being an alcoholic. She’d had gastric bypass surgery done 11 years ago. She ended up with a perforated bowel that couldn’t be fixed. (Sepsis and Perforated Bowel) She got put on a ventilator so we could drive the 2 hours to hospital to be with her as she passed. I’m a mental wreck. Read Full Story

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Mary Lansing

Survivor, Survivor, Tribute, Tribute

This story is about my mother Mary. She was a healthy dialysis patient. (Sepsis and Invasive Devices) She didn’t want to get an infection so she agreed to have a graft put under her skin which was safer than having a dialysis catheter. She always was careful to follow the doctor’s advice. One night after dialysis, she got up from bed to go to the bathroom. And got dizzy and fell and broke her ankle in many places. When she got to the emergency room, she was found to be septic and that was what caused her to fall. Not ... Read Full Story

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Shannon Martin

Survivor, Survivor, Tribute, Tribute, Survivor

On September 29, 2019 my day started out with me feeling a little nauseous so I thought I was coming down with something. Later in the day my stomach was cramping like it always does when I have to go number 2. Only I couldn’t go. Then the cramps turned to pain that continued to get worse. Finally I told my husband to take me to the hospital. By the time we got there the pain was so bad I couldn’t talk. I cried and vomited because that was all I could do. The rest was a blur. My husband ... 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.