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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.

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 often deadly response to infection. Sepsis kills and disables millions and requires early suspicion and treatment for survival.

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 a foreign object that was swallowed
  • 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 will be done to 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, and a second surgery is not needed.

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.

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.

Updated May 11, 2021.