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

Heather E

Survivor

My daughter had gastric bypass resection on 10/14/20. (Sepsis and Surgery) I picked her up from hospital on 10/15/20. On the morning of 10/16/20, she was in severe pain and I phoned EMS. She was taken to nearest hospital on that Friday, which was not a hospital her bariatric surgeon was affiliated. CT scan revealed “free air” perforation. Seven hours later, she was transferred to hospital where bariatric surgeon was affiliated. Another CT scan with contrast was performed, confirming perforation. (Sepsis and Perforated Bowel) She was intubated, antibiotics, etc., but no surgical procedure until Wed., 10/21/20. That was 6 weeks ... Read Full Story

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Michael Williamson

Survivor, Survivor

I wish to formally thank my nurse, Michelle, who cared for me. Following emergency colon surgery (diverticulitis and a perforated colon) on September 8, 2021, I struggled to breathe and see for a few hours. (Sepsis and Perforated Bowel, Sepsis and Surgery) At 2:58 a.m. on September 9, 2021, my heart and lungs stopped. Cardiac arrest. Pulmonary failure. Renal failure. I went into asystole. I was suffering from sepsis. According to my reading as a layperson, I only had about a 10 percent chance of surviving this event. My wife (who was right there), said that RN Michelle IMMEDIATELY called ... 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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Evangelina Elysee

Survivor, Survivor, Tribute, 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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Shannon Martin

Survivor, Survivor, Tribute, Survivor, 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.