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

Evangelina Elysee

Survivor

Hi all! I recently began sharing my story with people on Facebook groups for survivors. Several who have read it found it inspiring and helpful, and recommended I share it here. In 2014, I developed septic shock resulting from a perforated bowel, died, and brought back to life. (Sepsis and Septic Shock, Sepsis and Perforated Bowel) I was in a coma for almost 3 weeks, and could not walk for many months after. Because of medical mishap, I developed recurring sepsis that left me hospitalized every month for 2 years. Because of complications from all this, I was barely able ... Read Full Story

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Ingrid Halvorsen

Survivor, Survivor

I had laparoscopic bariatric revision (RNY>RNY) surgery on 12/21/21 which appeared to be successful. On 12/28/21 I had a follow-up visit with my surgeon during which a drain tube was removed. My vitals were normal and I appeared to be recovering as expected, but still very tired. Three days later, on the afternoon of 12/31/21, I lay down for a nap. I woke up coughing up blood. I immediately called 911. When the EMTs arrived I was able to tell them that I had surgery 10 days previously. (Sepsis and Surgery) This was a key piece of information, because I ... Read Full Story

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Mary Lansing

Survivor, Survivor, 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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Jackie D.

Survivor, Survivor, Tribute, Survivor

I’ve suffered from Crohn’s and dysautonomia and other disabling autoimmune diseases for ten years. (Sepsis and Autoimmune Diseases) Last May I had multiple tooth abscesses and other medical procedures going on. (Sepsis and Dental Health) Two weeks after, our older daughter and our son graduated college and I was much more tired than usual. My family was watching TV that evening and I was curled up on the couch totally detached from everything going on, and my left hip was hurting worse than it ever had in a decade. Though exhausted, I couldn’t sleep all night, and by 5 a.m. ... Read Full Story

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Lynne H.

Survivor, Survivor, Tribute, Survivor, Survivor

My story started on the 28/04/2022 I went into hospital for a relatively routine stomach operation to stop reflux. I have no memory of ten days before the operation and no memory until the start of June 2022. (Sepsis and Surgery) I was apparently in agony after my op. It wasn’t until 48hrs after that they were concerned enough to take me back to theatre. There they found that my bowel had been perforated. (Sepsis and Perforated Bowel) This caused sepsis and I was put into a coma on critical care for a month. On waking I suffered from delirium ... 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.