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Ruptured Bowel

Reviewed 06/2018
 


BASICS

DESCRIPTION

  • A perforation of the GI endothelium extending through the visceral wall into the peritoneal cavity, allowing GI contents to enter the peritoneum. Leakage can result in bacterial and/...

DIAGNOSIS

ALERT

A ruptured bowel with peritonitis is a surgical emergency.

 
  • A workup should not delay definitive treatment in the setting of peritonitis.

HISTORY

  • Abdominal pain: often sudden onset or afte...

TREATMENT

General resuscitation 
  • Admit to hospital.

  • Crystalloid fluid resuscitation to achieve early goal-directed therapy if the patient is in septic shock

    • Mean arterial pressure: >65 mm Hg

    • Urine outp...

ONGOING CARE

FOLLOW-UP RECOMMENDATIONS

  • Peptic ulcer disease

    • Compliance with acid-reducing medications

    • If ulcers do not heal, consider Zollinger-Ellison syndrome or malignancy; repeat endoscopy.

  • Diverticul...

REFERENCES

1
Schiessel R. The research progress of acute small bowel perforation. JAD.  2015;4(3):173–177.
2
Taourel P, Merigeaud S, Millet I, et al. Trauma of the thoraco-abdominal area: imaging st...

ADDITIONAL READING

  • Bertleff MJ, Lange JF. Perforated peptic ulcer disease: a review of history and treatment. Dig Surg.  2010;27(3):161–169.

  • Kloss BT, Broton CE, Sullivan AM. Perforated Meckel div...

CODES

ICD10

  • K63.1 Perforation of intestine (nontraumatic)

  • K26.5 Chronic or unspecified duodenal ulcer with perforation

  • K35.2 Acute appendicitis with generalized peritonitis

  • K57.20 Diverticulitis of large ...

CLINICAL PEARLS

  • Bowel perforation is often a clinical diagnosis.

  • A high index of suspicion in patients at the extremes of age and patients with multiple comorbidities avoids delays in diagnosis and tre...

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