What Is A Ruptured Bowel?

I’m trying to find out more about ruptured bowels treatment plans after surgery and long-term effects. Everything I’ve found is on irritable bowel syndrome (IBS). I can’t find anything on ruptured bowels.

By ruptured bowels, I assume you are referring to perforation of the bowel, a catastrophic event which can complicate many different illnesses. Interestingly, irritable bowel syndrome is probably one of the few conditions which does not lead to perforation of the bowel.

Why is a perforation such a catastrophe? To understand one needs to know that the stomach, most of the duodenum, all the small intestine and most of the colon, or large intestine, are floating rather freely inside our abdomens, in the space called the peritoneal space. This space, lined by a type of membrane called the peritoneum, is not designed to have any bacteria or other foreign substances introduced into it. Its ability to resist infection is very small, and for this reason generalized peritonitis, as infection in this space is called, was always fatal in the pre-surgery, pre-antibiotic days.

The inside of our stomach and intestine is in some ways very much like the world outside us. We swallow food and water containing millions of germs all the time. Bacteria are common in normal people in the stomach, the first part of the small intestine, and throughout the entire colon. I’m not talking about someone with a particular infection, I’m talking about all normal people. Therefore, when a perforation occurs, the intestinal juices, often laden with bacteria, pour out into the peritoneal space, causing peritonitis.

If the perforation is not rapidly closed by surgery, and the infection effectively treated with antibiotics, a person with peritonitis will die painfully within a few days.

So what conditions can cause a perforation? Any penetrating trauma, a knife wound or bullet wound, can go right through loops of bowel, perforating them. This is why all penetrating trauma to the abdomen must be surgically explored, and the surgeon literally checks every inch of the bowel for any sign of a perforation. In the stomach and duodenum, perforation by an ulcer is a common cause. Cancer in the stomach may also perforate. In the small intestines, ulcers and diverticulae, small outpouchings from the lining of the intestine can also perforate but are less common.

In the old days the most common form of perforation were from the appendix at the junction of the small intestine and the colon. Appendicitis would generate pus and pressure in the appendix, which would be weakened by the infection. Perforation would release all those germs into the peritoneum, leading to peritonitis. Occasionally, the perforation would happen in such a way that generalized peritonitis did not follow, and the released pus would be sealed up as an abscess, still not a fun thing to have, but perhaps not fatal.

Now the most common type of perforation is the perforation of a diverticulum in the colon following diverticulitis. Diverticulae in the colon are extremely common, and occasionally the outpouching can become infected in a way similar to the appendix. If not treated, the diverticulum may rupture, releasing large amounts of stool and bacteria into the peritoneal space.

How can someone tell if they have a perforation of the bowel? Usually the condition leading to the perforation will be known, or will cause enough symptoms before the perforation occurs to alert the person that something is wrong. The ulcer patient will probably have known that something was wrong in his abdomen for a long time, and when the acute sharp pain that accompanies a perforation occurs, he’ll probably not hesitate to get to the emergency room.

Perforation of the appendix can be misleading though, because the pain of the appendicitis is often reduced when it perforates. As the pressure in the inflamed organ drops the pain drops as well. And although the bacteria released will be deadly if not treated, they do not cause the immediate pain that acid stomach juice causes when the stomach perforates.

In the old days it was not uncommon for a person with appendicitis to think that they were getting better when they perforated, and therefore delayed getting treatment until the infection was widespread and then often incurable. Now all doctors are so alert to the possibility of appendicitis that allowing someone to get that far would be unusual.

Perforation of diverticulitis, if it occurs, will also now be picked up immediately by a doctor, since the diverticulitis is usually painful enough to have brought the person to the doctor’s office or emergency room. Prompt surgery to remove the perforated portion of bowel and clean up the infection will be life saving.

Peritonitis from any cause, even if promptly treated, may have long term complications. The inflamed loops of intestine tend to stick together, and even if the infection is overcome, scarring of the loops may result in adhesions. Such adhesions can be a cause of long term abdominal cramping pain and even intestinal obstructions, which may require more surgery.

 

The information provided on Health Search Online is for educational purposes only and is not a substitute for medical advice, diagnosis or treatment.