Perforated Bowels: Causes, Symptoms & Treatment

Instructor: Dan Washmuth

Dan has taught college Nutrition, Anatomy, Physiology, and Sports Nutrition courses and has a master's degree in Dietetics & Nutrition.

A perforated bowel is a potentially life-threatening condition. Learn all about perforated bowels, including the causes, symptoms, and treatments for this medical emergency.

Severe Stomach Pains

Nicole is a 28-year-old social worker who was diagnosed with Crohn's disease several years ago. She has managed her Crohn's disease over the years by following a very careful diet and taking the medications that her doctor has prescribed. However, over the past few days, Nicole has been suffering from a Crohn's flare-up that includes severe stomach pains as well as a high fever.

Worried about these symptoms, Nicole decided to go to the emergency room to get evaluated by a doctor. After running several tests, the doctor informed Nicole that she has a perforated bowel caused by her Crohn's disease and that she needed to be rushed into surgery to repair the damage.

What Is a Perforated Bowel?

A perforated bowel is a hole or tear that occurs anywhere in the lower part of your digestive system, which includes the stomach, small intestine, and colon. A perforated bowel is a serious medical emergency that requires immediate treatment. Gastrointestinal contents, such as bile, bacteria, stool, and other harmful substances, can leak through the perforation in the bowel and get into the abdominal cavity. If these substances get into the abdominal cavity or other parts of the body, it can lead to potentially life-threatening, widespread infection.

A bowel perforation is a hole or tear that occurs anywhere in the lower GI tract, including the stomach, small intestine, and colon.
lower GI


There are many different conditions and situations that can cause or increase a person's risk for developing a bowel perforation. These include:

  • Puncture wound to the bowel (such as a knife wound)
  • Appendicitis
  • Cancer
  • Inflammatory bowel diseases (Crohn's disease, colitis)
  • Diverticulitis
  • Bowel infection
  • Ulcers to the GI tract
  • Abdominal surgery
  • Colonoscopy
  • Bowel obstruction


As previously mentioned, a bowel perforation can cause gastrointestinal contents to leak into the abdominal cavity and other parts of the body, which can potentially lead to very serious infections. These infections can include sepsis (widespread bacterial infection) and peritonitis (infection of the peritoneum, which is the membrane that lines the abdominal wall). Symptoms of these infections include:

  • Abdominal pain
  • Fever and chills
  • Nausea and vomiting
  • Decreased appetite

One of the most common symptoms of a perforated bowel is severe abdominal pain.
stomach pain


Since a perforated bowel can be a potentially life-threatening condition, it requires immediate medical attention. Treatment usually involves emergency surgery to repair the perforation or hole. During surgery, the hole or perforation may be stitched closed or part of the GI tract may need to be completely removed. In some severe perforations in the colon, a colostomy may be required, a procedure in which part of the colon is brought through an artificial opening in the abdomen (stoma) in order to bypass the perforated section of the GI tract.

Additionally, antibiotics can be used to help treat and prevent bacterial infections caused by the gastrointestinal contents getting into the abdominal cavity.

Severe perforations in the colon may require a colostomy.

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