In the case of a so-called intestinal perforation or intestinal perforation, physicians usually speak of an extremely severe clinical picture. In some circumstances, intestinal perforation develops into a life-threatening situation for those affected.
What is intestinal perforation?
In modern medicine, an intestinal perforation represents a local breakthrough of the intestinal wall. As a result, the contents of the intestine can enter the abdominal cavity of the affected person unimpeded. An intestinal perforation can appear in different forms. In modern medicine, a basic distinction is made between a free intestinal perforation and a covered intestinal perforation. In the case of a covered intestinal perforation, the affected person has a significantly higher chance of survival. It is not uncommon for adjacent organs to prevent the intestinal contents from entering the abdominal cavity.
Causes
Different causes are responsible for the occurrence of intestinal rupture. Basically, however, the causes bring about a change in relation to the structure of the intestinal wall. For example, leading physicians cite inflammation of the intestine as one possible cause of intestinal rupture. In most cases, these inflammations lead to a disturbance of blood flow in the area of the intestinal wall. If there are harmful germs in the intestinal flora, the affected person suffers from an inflammation of the appendix. If left untreated, inflammation of the appendix can lead to intestinal rupture. In addition to the causes already mentioned, external factors also favor the occurrence of an intestinal rupture. Here, the so-called abdominal trauma plays an essential role. If the body is exposed to an extremely strong force, it can lead to a severe injury of organs in the abdominal cavity. However, in addition to ulcers, the use of various sexual practices (e.g. anal intercourse with large objects) is also considered a cause for the occurrence of intestinal perforation. In most patients, dangerous intestinal perforation also occurs after acute constipation. Because the intestinal contents have not been evacuated for an extended period of time, the volume within the intestine increases. The relatively thin wall of the intestine often cannot withstand this stress.
Symptoms, complaints, and signs
Acute abdomen typically manifests as severe abdominal pain in the stomach or lower abdomen. This pain usually occurs suddenly and is very intense. The pain may radiate throughout the abdomen and, in severe cases, may also affect the limbs. Then, for example, there are cramps in the arms and legs, which in turn are associated with discomfort and complications. A rupture of the intestine can be recognized by the hardened abdominal wall. In addition, bowel movements are absent or occur only irregularly. The stool is usually bloody and dark red. In most cases, the abdomen causes severe nausea and vomiting, but it can also be relatively symptom-free. Free rupture of the bowel may result in peritonitis, which is accompanied by typical febrile symptoms. Acute abdomen is generally associated with severe malaise. The affected person feels ill and suffers from sweating, circulatory problems and fatigue. Accompanying this, there may be severe failure to thrive. In severe cases, intestinal rupture leads to circulatory collapse and ultimately to the death of the patient. For this reason, mentioned symptoms must be immediately clarified and treated by an emergency physician.
Diagnosis
An intestinal rupture can be diagnosed by the respective family doctor as well as by the doctors in the hospital. As part of an initial examination, the abdomen of the affected person is palpated. Often the abdominal wall is extremely hard, as the body builds up a so-called defensive tension. At the same time, those affected complain of severe pain during the examination. In addition, imaging techniques are generally used to diagnose a hernia of the intestine. For example, intestinal rupture can be diagnosed during an examination with ultrasound. If X-rays are used as a method for diagnosing intestinal perforation, the patient must stand during the examination. This is the only way to properly diagnose any air that may be present in the diaphragm area. For physicians, air in the area of the diaphragm is a clear sign of intestinal rupture.
Complications
In any case, intestinal perforation is a condition that requires treatment. To minimize serious complications, the patient must seek immediate medical attention if a bowel perforation is suspected. Intestinal perforations must be treated surgically. Possible complications therefore also arise from the type of therapy. In less complicated cases, the patient can leave the hospital again after a relatively short time. To avoid consequential damage, it is important to take sufficient rest. Otherwise, there is a risk of the organ rupturing again. Complications are more likely to occur with larger bowel injuries than with smaller ones. Existing underlying diseases can also increase the risk of complications. Another potential problem is infection of the wound. There is also a risk that the patient will develop what is known as peritonitis. Such peritonitis occurs when bacteria from the injured intestine migrate via the blood into the abdominal cavity. As a result of this inflammation, lack of fluids and low blood pressure are other problems that can occur. In combination, this can lead to circulatory shock. If the bacteria enter the bloodstream, the risk of sepsis increases, which can be life-threatening.
When should you see a doctor?
Bowel perforation is a life-threatening and acute condition for the affected person. For this reason, a doctor should be consulted as soon as possible when discrepancies occur. Persistent discomfort during the digestive process or in the region of the abdomen should be examined and treated by a doctor. If the discomfort increases in intensity or spreads further into the lower abdomen, a doctor is needed. Pain, bleeding or a change in bowel movements are considered unusual and should be investigated. If there is fever, constipation, vomiting or diarrhea, a doctor’s visit should be made. If pus comes out of the anus, there is swelling of the skin and a general feeling of discomfort, it is advisable to see a doctor. If there is a feeling of pressure in the abdomen, a drop in the general performance level, pain on movement or an inner restlessness, a doctor is needed. As soon as the complaints persist for several days and there is no obvious reason, due to psychological stress or an unhealthy food intake, consultation with a doctor is necessary. If disturbances of consciousness occur or if the affected person suddenly cannot move without help, an emergency doctor is needed. First aid measures must be carried out until the doctor arrives. Before taking medication, consultation with a medical professional is always necessary.
Treatment and therapy
An intestinal perforation basically requires rapid treatment. Since intestinal perforation is a life-threatening situation for the affected person, surgery must always be performed. During surgery, the affected area is closed. If the contents of the intestine have penetrated into the abdominal cavity, the affected person is also treated with a so-called antibiotic. In addition, intensive medical monitoring is essential for a period of approximately 10 days. The administration of the antibiotic is intended to kill dangerous germs. This is the only way to prevent a life-threatening inflammation. If the acute intestinal rupture is based on cancer, in most cases a part of the intestine is removed. This is the only way to prevent the formation of metastases in other areas of the body. Often, an artificial anus is placed as part of this therapy.
Outlook and prognosis
If the intestine ruptures, a life-threatening condition occurs without prompt medical attention. The individual’s demise is imminent due to organ failure. Emergency treatment and surgery must stabilize the patient as quickly as possible to ensure survival. If intensive medical treatment succeeds in closing the affected area immediately and well, there is a good prognosis and chance of recovery. The patient can be discharged from treatment after a few weeks as symptom-free. In the further course, rest and overexertion must be refrained from. However, everyday activities can be performed as usual. In addition to rapid treatment, the underlying disease is largely responsible for the prospects of recovery.If an intestinal defect is present, it must be clarified whether this is a regenerative or chronic disease. If the intestinal contents have been distributed in the abdominal cavity as a result of the intestinal perforation, subsequent drug treatment is required. Germs must be fought and killed to prevent inflammation or sepsis. If blood poisoning occurs, the patient is also in a life-threatening condition. If other secondary diseases develop, the healing process is delayed by several weeks or months. Recovery is nevertheless possible with good treatment and occurs in most patients.
Prevention
Intestinal rupture can be effectively prevented by, among other things, eating a high-fiber diet. Dietary fiber is a major contributor to healthy intestinal flora. In addition, the intake of dietary fiber stimulates digestion. Any constipation can thus be actively prevented. It is responsible in most cases for the occurrence of intestinal perforation.
Aftercare
The aftercare of a bowel perforation depends entirely on the underlying cause. Provided the hernia was caused by cancer, the attending physicians most likely removed ulcers, tumors, and possibly even part of the bowel during emergency surgery. In these cases, follow-up care consists of regular control appointments with colonoscopy, laboratory control and ultrasound checks, as well as keeping appointments for radiation or chemotherapy. For all other causes of disease, treatment of the underlying disease is usually sufficient, and the patient should strictly adhere to the physician’s instructions. In any case, patients must take antibiotics postoperatively, as this kills dangerous germs and prevents inflammation of the surrounding organs. For this purpose, affected patients are initially monitored in intensive care for up to ten days in order to be able to react quickly to any complications. The intestinal perforation itself does not require any further follow-up after a final check by the physician. If complications occur in the form of wound healing disorders, infections, bruising, secondary bleeding or, in the worst case, intestinal obstruction, which are mainly caused by underlying diseases, the attending physician must be consulted immediately. To prevent a new intestinal perforation, it is helpful to change to a healthy diet rich in fiber. This keeps the intestines active, ensures healthy intestinal flora and prevents blockages that could damage the intestinal wall.
Here’s what you can do yourself
A ruptured bowel is an acute condition that requires immediate treatment by an emergency physician. Accompanying first aiders should perform first aid measures and, for example, place the affected person in the recovery position. After treatment, the affected person should be on strict bed rest. The physician will also prescribe dietary measures and arrange for further examinations. In this way, the acute symptoms can be alleviated and a new intestinal rupture can be reliably prevented. With the doctor’s approval, alternative remedies can be used. For example, anise, gentian or fennel, which can be used in the form of teas, compresses or warm baths, have proven effective for intestinal problems. Homeopathic remedies such as Schüßler salts or healing earth can also be tried after consultation with the responsible medical practitioner. In the case of a severe course, on the other hand, therapeutic measures are advisable. If, for example, the intestinal rupture results in bed confinement, a specialist can help the patient to accept the new living conditions. Attending a self-help group for chronic intestinal diseases is also an important step for many sufferers. The best way to find out which specific measures can be considered and are covered by health insurance is to discuss them with your family doctor.
