• Colon Perforation

    (Perforated Colon; Puncture of Colon)

    Definition

    Colon perforation is a hole in the wall of the colon. The colon is the end of the intestines also known as the large intestine.
    A perforation may be a puncture, cut, or tear. The opening allows air and intestinal material to leak into the abdominal cavity. The material can lead to a serious infection.
    Normal Colon
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    Causes

    A perforation may be caused by:
    • Direct trauma to the wall of the intestine
    • Increased pressure against a weakened area of intestine
    • Breakdown of intestinal wall by infection or disease

    Risk Factors

    Any surgical procedure of the colon increases the risk of perforation. Colonoscopy is a common bowel procedure, but the risk of perforation is small.
    Certain conditions can weaken the walls of the colon and increase the risk of perforation. These conditions include:

    Symptoms

    Symptoms may include:
    • Severe abdominal pain, may start shortly before the perforation
    • Fever
    • Bloody bowel movements

    Diagnosis

    A perforation during a procedure may be seen when it happens. If you have symptoms shortly after a procedure your doctor may suspect a perforation.
    If you did not have a recent procedure you doctor will ask about your symptoms and medical history. A physical exam may be done. Blood tests may be done to look for any signs of infection.
    Air and fluids in the abdominal cavity indicate a leak from the intestine. This leak may be seen with:

    Treatment

    Treatment will depend on the size of the perforation and how long it has been open.
    Smaller perforations may be able to seal themselves. In this case, you may be monitored for any changes. Additional imaging test will be taken to make sure there is no more air or fluids moving into your abdominal cavity. You will also be given antibiotics to prevent infection in the abdominal cavity.
    Larger perforations and those that have existed for some time without notice will require more care:

    Surgical Repair

    Surgery may be needed to repair some perforations and clean leaked material from the area. The extent of surgery will depend on the size of the perforation and presence of infection.
    A small perforation may be closed with no other repairs needed.
    Some larger perforations or those with serious infections can cause damage to some of the surrounding tissue. This may require the removal of parts of the intestine. It may also require a temporary or permanent colostomy.

    Antibiotics

    Infections can be very serious with colon perforations. The material that moves out of the intestines can contain numerous bacteria and other organisms. The material can cause an infection in the nearby tissue or throughout the body (called sepsis).
    Antibiotic medications may be recommended to treat an infection or prevent an infection from developing.

    Prevention

    Some perforations are caused by accidents which are difficult to prevent.
    Some intestinal disorders can increase the risk of perforations. Proper management of these disorders may prevent damage and weakening of the intestinal wall.

    RESOURCES

    American Society for Gastrointestinal Endoscopy https://www.asge.org

    National Institute of Diabetes and Digestive and Kidney Diseases https://www.niddk.nih.gov

    CANADIAN RESOURCES

    Canadian Association of Radiologists http://www.radiologyinfo.ca

    Public Health Agency of Canada https://www.canada.ca

    References

    Acute perforation of the GI tract. Merck Manual Professional Version website. Available at: http://www.merckmanuals.com/professional/gastrointestinal-disorders/acute-abdomen-and-surgical-gastroenterology/acute-perforation-of-the-gi-tract. Updated January 2017. Accessed October 3, 2017.

    Colonoscopy. American Gastroenterological Association website. Available at: http://www.gastro.org/patient-care/procedures/colonoscopy. Accessed October 3, 2017.

    Revision Information

    • Reviewer: EBSCO Medical Review Board Daus Mahnke, MD
    • Update Date: 10/03/2016
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