Colon perforation refers to the occurrence of a hole or tear in the wall of the large or small intestine, which usually results in the release of intestinal contents into the abdominal or otherwise peritoneal cavity. This results in an increased chance of developing a serious infection known as peritonitis. The intestine is a dominant organ of the body, therefore the violation of its integrity can have significant effects on the overall health of the patient. Colon perforation in particular is an emergency that requires immediate medical attention.
What can cause colon perforation?
The causes of colon perforation are varied and can be broadly categorized into traumatic and non-traumatic. Traumatic causes include accidental injuries during an accident or a fall. These causes also include some sort of surgery or endoscopic diagnostic examination that may inadvertently damage the intestinal wall. This organ injury may also occur as a result of swallowing foreign bodies, caustic liquids or sharp objects.
Non-traumatic causes include a number of conditions, the main ones being:
- Diverticulitis: Inflammation of diverticula (small, swollen sac-like protrusions in the wall of the large intestine) leading to colon perforation.
- Appendicitis: Inflammation of the appendix increases the risk of perforation.
- Idiopathic inflammatory bowel diseases (Crohn’s disease and ulcerative colitis): These conditions cause long-term inflammation and ulcers in the digestive tract, increasing the risk of perforation.
- Colon cancer: Cancerous tumors that erode the wall of the colon may cause the condition.
- Ischemic colitis: Decreased blood flow to the colon leading to necrosis and perforation.
- Infections such as tuberculosis increase the risk of perforation.
- Use of steroids or certain other drugs such as chemotherapy drugs that weaken the bowel wall.
Intestinal perforation symptoms and complications
Patients with intestinal perforation may experience a range of symptoms, the predominant one being severe abdominal pain. Fever and chills, nausea and vomiting, abdominal distension, tenderness and stiffness in the abdomen, inability to pass gas or stool, tachycardia, hypotension (low blood pressure) or even signs of sepsis in severe cases are also manifested.
Bowel perforation can lead to several serious complications, mainly due to leakage of intestinal contents into the peritoneal cavity. The most immediate and worrisome complication is peritonitis, an acute inflammatory response caused by the introduction of bacteria and feces into the peritoneal cavity. This inflammation can lead to widespread infection and sepsis, a life-threatening condition characterized by a systemic inflammatory response that can lead to organ failure. In addition, the presence of foreign material and bacteria in the abdominal cavity can lead to the formation of abscesses, localized pockets of infection that may require surgical drainage. Another serious complication is acute intestinal obstruction, which can occur either because of adhesions that form in response to inflammation or because of the direct effect of perforation on intestinal motility. Additionally, prolonged infection and inflammation can lead to scarring and strictures in the colon, potentially causing chronic bowel obstruction and discomfort.
Appropriate treatment for colon perforation
The treatment of the condition is mainly surgical and aims to manage the perforation and control the infection. In fact, this is one of the few cases where open surgery is indicated over the laparoscopic approach. Depending on the extent and location of the perforation, surgery may include repair of the hole, resection of part of the bowel, or creation of colostomy. The General Surgeons in Athens, who make up the Colon Rectal medical team, treat intestinal perforation surgically, in order to prevent life-threatening complications for the patient. In some cases and if there are definite indications, intestinal perforation can be treated with conservative measures that include possible drainage and intravenous administration of broad-spectrum antibiotics.
