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Ruptured Bowel

Prachi Shah, DO and Roxanne Smith, MD, MPH Reviewed 06/2019
 


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.

 
Do not delay treatment for pending workup if peritonitis is suspected. 

HISTORY

  • Abdominal pain: often sudden onset or after a sp...

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 ou...

ONGOING CARE

FOLLOW-UP RECOMMENDATIONS

  • Peptic ulcer disease

    • Acid-reducing medications

    • Eradication of H. pylori

    • Follow-up endoscopy after surgery to rule out malignancy (5)

  • Diverticulitis

    • High-fiber diet...

REFERENCES

1
Schiessel R. The research progress of acute small bowel perforation. JAD.  2015;4(3):173–177. [View Abstract on OvidMedline]
2
Søreide K, Thorsen K, Harrison EM, et al. Perforated pepti...

ADDITIONAL READING

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

  • Kloss BT, Broton CE, Sul...

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.

  • Maintain a high index of suspicion in patients at the extremes of age and patients with multiple comorbidities to avoid delay in diagnos...

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