Topic 41: Acute Surgical Abdomen – Perforation Causes, Symptoms, Diagnosis, Treatment
I. Definition
A perforation in the gastrointestinal tract is a full-thickness defect in the wall of a hollow organ, allowing the escape of contents (air, fluids, bacteria) into the peritoneal cavity, leading to chemical and bacterial peritonitis.
Perforation is a surgical emergency.
II. Common Causes of GI Perforation
III. Symptoms and Signs
IV. Diagnosis
A. Clinical Suspicion
- History of ulcer, trauma, diverticulitis, sudden pain
- Classic triad: sudden pain + rigidity + rebound
B. Imaging:
V. Management
Main goals: Resuscitate → control sepsis → close perforation
1. Resuscitation (Always First):
- NPO
- IV fluids (Ringer's lactate or NS)
- Oxygen
- NG tube: decompress GI tract
- Urinary catheter: monitor output
- IV broad-spectrum antibiotics: e.g., ceftriaxone + metronidazole
- Pain control (after diagnosis)
2. Surgery (Definitive Treatment)