saudigastro.com/patients/bowel-perforation
Category
Serious
Red flags
4
This article is educational and does not replace your doctor's advice. Seek urgent care for any red-flag symptoms.
What is it?
Perforation means a hole or tear in the wall of the stomach, small bowel or colon. Digestive contents and bacteria then spill into the abdominal cavity, causing peritonitis (severe inflammation and infection of the abdominal lining) and sometimes blood poisoning (sepsis). It needs urgent hospital treatment, often surgery.
How common is it?
Bowel perforation is not common, but it is one of the most serious abdominal emergencies. It is more likely in people with certain underlying problems and after some procedures, though the overall chance with procedures such as endoscopy is low.
Why does it happen?
Causes include peptic ulcers that erode through the stomach or duodenal wall, diverticulitis (infected pouches in the colon), severe appendicitis, bowel obstruction, severe colitis, tumours, injury to the abdomen, swallowed sharp objects or magnets, and rarely complications of endoscopy or surgery. Anti-inflammatory painkillers, steroids, and a weakened immune system raise the risk.
Symptoms
- Sudden, severe abdominal pain that gets worse with movement
- A hard, board-like abdomen that is very tender
- Nausea and vomiting
- Fever and chills
- Fast heartbeat and fast breathing
- Swollen belly, and sometimes shoulder-tip pain
Red flags — seek urgent medical care
Sudden severe abdominal pain with a rigid belly
A possible perforation. Call emergency services or go to the ER immediately.
Pain after an endoscopy, colonoscopy or surgery that is getting worse, with fever or a swollen belly
A rare procedure complication. Return to the hospital immediately.
Fainting, cold sweaty skin, confusion or very low urine
Signs of shock or sepsis. Emergency, call an ambulance.
Swallowing a sharp object, a button battery or magnets
Go to the ER immediately, even if there is no pain. This is especially urgent for children.
How is it diagnosed?
Doctors examine the abdomen and take blood tests. A chest or abdominal X-ray may show air under the diaphragm. A CT scan is the most accurate test and usually shows the site and cause of the hole. Diagnosis must be fast, and treatment often begins while tests are done.
Outlook — what to expect
Perforation is dangerous, and the outcome depends on how quickly it is treated, the site of the hole and the patient's overall health. Early surgery and antibiotics lead to better results. Older people and those with other illnesses are at higher risk of complications, so do not wait.
Treatment
Habits & Lifestyle
This is an emergency with no home treatment.
- Call emergency services or go to the nearest ER immediately.
- Do not eat, drink, or take painkillers, laxatives or enemas while waiting.
- Do not drive yourself.
- After recovery, follow your surgeon's activity and wound-care advice.
Diet
Nothing by mouth until the medical team says otherwise.
- You will receive fluids through a vein, and sometimes a tube in the stomach to keep it empty.
- Nutrition support through a vein may be used if you cannot eat for some time.
- Food is reintroduced slowly after surgery, guided by the team and a dietitian.
Medications
Drugs support surgery; they do not replace it.
- Intravenous antibiotics to treat or prevent infection in the abdomen.
- Intravenous fluids and pain relief.
- Acid-lowering medicine if an ulcer is the cause, and H. pylori treatment later if present.
- Avoid anti-inflammatory painkillers (NSAIDs) after an ulcer perforation unless your doctor approves.
Procedures & Surgery
Most perforations need an operation.
- Surgery repairs the hole or removes the damaged segment of bowel and washes out the abdomen.
- A temporary or permanent stoma (a bowel opening on the abdomen) is sometimes needed.
- Small, contained perforations in selected, stable patients may be managed with antibiotics, fasting and close observation, or an endoscopic clip, under specialist care.
- Intensive care may be needed after surgery for very ill patients.
Questions to ask your doctor
Save this list or print it before your appointment — doctors appreciate prepared patients.
- What caused the perforation in my case?
- Will I need a stoma, and will it be temporary?
- How long is the recovery and when can I go back to normal activities?
- Which medicines should I avoid in future?
- What symptoms after discharge should bring me back immediately?
Was this guide helpful?
Status: Approved for publication by SGA; individual clinician review is ongoing · Published 24/04/2026
For general education only; it does not replace your doctor’s advice. Individual clinician review of this guide is ongoing. SGA clinician? Review this guide