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Potentially life-threatening emergency
Bowel perforation
Other Resources UpToDate PubMed
Potentially life-threatening emergency

Bowel perforation

Contributors: Michael W. Winter MD, Christine Osborne MD, Nishant H. Patel MD, Desiree Rivera-Nieves MD, Khaled Bittar MD, Paritosh Prasad MD
Other Resources UpToDate PubMed


A bowel perforation refers to a rupture in the lumen of the small or large intestine. Perforations lead to intraperitoneal contamination with bowel contents and place patients at high risk for subsequent abscess formation, sepsis, and septic shock.

Causes of perforation include peptic ulcer disease (mostly duodenal), small and large bowel malignancies with tissue invasion, acute diverticulitis, acute appendicitis in the elderly population, inflammatory bowel disease, trauma, consequence of ischemic injury, and ingestion of foreign bodies (including fish or poultry bones), or it may occur as a complication of endoscopic procedures.

A patient will typically present with abdominal pain as well as signs of severe inflammatory response syndrome (SIRS criteria). The patient may have an acute abdominal examination with a rigid abdomen and minimal to no bowel sounds, although the examination can be misleading and may be unremarkable (particularly in immunocompromised patients or those on steroids).

The etiology of the perforation often depends on the history. Recent endoscopic procedures, known malignancies, prior bouts of diverticulitis, or a history of inflammatory bowel disease provide insight into the potential underlying cause of a perforation.


K63.1 – Perforation of intestine (nontraumatic)

56905009 – Perforation of intestine

Look For

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

  • Acute appendicitis
  • Perforated peptic ulcer (see Peptic ulcer disease)
  • Ulcerative colitis
  • Crohn disease
  • Acute pancreatitis
  • Ascending Acute cholangitis
  • Endometriosis
  • Salpingitis
  • Ectopic pregnancy
  • Isolated tubal torsion with ovarian sparing
  • Ovarian cysts
  • Ovarian torsion
  • Testicular torsion
  • Infectious colitis (eg, Clostridioides difficile colitis, Amebic colitis)
  • Streptococcus pneumoniae pneumonia
  • Acute coronary syndrome
  • Pyelonephritis
  • Renal calculus
  • Hepatic infarction
  • Renal infarction
  • Ischemic colitis

Best Tests

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Management Pearls

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Drug Reaction Data

Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.

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Last Reviewed:03/15/2021
Last Updated:10/17/2022
Copyright © 2024 VisualDx®. All rights reserved.
Potentially life-threatening emergency
Bowel perforation
A medical illustration showing key findings of Bowel perforation : Abdominal pain, Abdominal distension, Hypoactive bowel sounds, Foreign body exposure
Imaging Studies image of Bowel perforation - imageId=7877196. Click to open in gallery.  caption: '<span>Axial CT image demonstrates  numerous foci of free intraperitoneal air secondary to a large bowel  perforation (found intraoperatively)</span>.'
Axial CT image demonstrates numerous foci of free intraperitoneal air secondary to a large bowel perforation (found intraoperatively).
Copyright © 2024 VisualDx®. All rights reserved.