Bowel Perforation

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Definition

-  Perforation of bowel wall leading to communication between GIT & peritoneal cavity

 

Features

-  Surgical Emergency

-  May lead to abscess

-  Overall mortality 20-40%

-  Types

-  Free: GIT contents into cavity --> peritonitis

-  Contained: spillage prevented by organs

 

Associated S/S

-  Septic shock

-  Severe abdo pain worse on movement

-  Guarding, rigidity

-  Nausea, vomiting

-  Shoulder pain

-  Peritonitis

 

Causes

-  PUD

-  Diverticulitis

-  Ca

-  ERCP, endoscopy

-  Trauma

-   Blunt trauma: seat belt..

-   Penetrating injury: small intestine

-  Sup. Mesenteric A. Syndrome

-  Acute appendicitis

-  IBD

-  Intestinal ischaemia

-  Bacterial infection

-  Foreign body

-  Caustic ingestion

 

Ix

-  AXR: Horizontal ray + left lateral decubitus

-  Pneumoperitoneum: Riglers sign (outline of bowel wall)..

-  CXR: pneumoperitoneum

-  FBE: WBC: elevated

-  PR Exam: appendicitis, Diverticulitis

-  BC

-  +/- DPL OR FAST

-  +/- CT - Abdo

 

Mx

-  Exploratory laparotomy +/- washout

-  Conservative Mx

-  IV Fluid

-  Abx

-  NGT + NBM

-  IV access

-  NBM

-  Analgesia: IV/SC Morphine

-  Antiemetics

-  Abx

-  Metronidazole 7.5mg/kg IV pre-op

-  Gentamicin 2.5mg/kg IV