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Emergency Medicine327 papers

Perforation of intestine

Last edited: 4/14/2026

Overview

Intestinal perforation is a severe complication often resulting from conditions like peptic ulcer disease, inflammatory bowel disease, or trauma, leading to acute abdominal pain, peritonitis, and potentially life-threatening sepsis if not promptly addressed 14.

Diagnosis

  • Clinical Presentation: Severe abdominal pain, tenderness, guarding, and signs of peritonitis 14.
  • Imaging: Abdominal X-rays, CT scans, or ultrasound to identify free air under the diaphragm or localized fluid collections indicative of perforation 14.
  • Laboratory Tests: Elevated white blood cell count, inflammatory markers, and electrolyte imbalances 14.

    • Management

  • Surgical Intervention: Primary repair or resection of the perforated segment, often requiring emergency surgery 14.
  • Antibiotics: Broad-spectrum coverage to prevent or treat sepsis 14.
  • Fluid Resuscitation: Aggressive intravenous fluid therapy to manage hypovolemia 14.
  • Source Control: Removal of necrotic tissue or foreign bodies if applicable 14.

    • Special Populations

  • Elderly: Higher risk of complications; careful monitoring and individualized care plans are essential 15.
  • Comorbidities: Presence of conditions like inflammatory bowel disease may influence both diagnosis and management strategies 14.

    • Key Recommendations

  • Prompt Surgical Evaluation and Intervention: Early surgical consultation and intervention are critical for survival in cases of suspected intestinal perforation 14 (Evidence: Strong).
  • Aggressive Fluid and Electrolyte Management: Maintain hemodynamic stability through aggressive fluid resuscitation 14 (Evidence: Strong).
  • Antibiotic Therapy: Initiate broad-spectrum antibiotics to cover potential sepsis 14 (Evidence: Strong).
  • Psychiatric Evaluation Post-Event: Consider psychiatric consultation for patients with a history of suicidal behavior to assess and manage mental health risks 710 (Evidence: Moderate).
  • Risk Assessment Tools: Utilize structured risk assessment tools in emergency settings to guide disposition and follow-up care 18 (Evidence: Moderate).
  • Documentation and Follow-Up: Ensure thorough documentation and arrange for comprehensive follow-up care to prevent recurrence and address underlying causes 14 (Evidence: Expert opinion).

    • References

    1 Lavigne JE, Gibbons JB. The association between vitamin D serum levels, supplementation, and suicide attempts and intentional self-harm. PloS one 2023. link 2 Fusaroli M, Pelletti G, Giunchi V, Pugliese C, Bartolucci M, Necibi EN et al.. Deliberate Self-Poisoning: Real-Time Characterization of Suicidal Habits and Toxidromes in the Food and Drug Administration Adverse Event Reporting System. Drug safety 2023. link 3 Schlump C, Thom J, Boender TS, Wagner B, Diercke M, Kocher T et al.. [Using emergency department routine data for the surveillance of suicide attempts and psychiatric emergencies]. Bundesgesundheitsblatt, Gesundheitsforschung, Gesundheitsschutz 2022. link 4 Peñas-Lledó EM, Guillaume S, de Andrés F, Cortés-Martínez A, Dubois J, Kahn JP et al.. A one-year follow-up study of treatment-compliant suicide attempt survivors: relationship of CYP2D6-CYP2C19 and polypharmacy with suicide reattempts. Translational psychiatry 2022. link 5 Bowden CF, True G, Cullen SW, Pollock M, Worsley D, Ross AM et al.. Treating Pediatric and Geriatric Patients at Risk of Suicide in General Emergency Departments: Perspectives From Emergency Department Clinical Leaders. Annals of emergency medicine 2021. link 6 Sher L, Bierer LM, Flory J, Hill MN, Makotkine I, Yehuda R. Endogenous cannabinoid levels and suicidality in combat veterans. Psychiatry research 2020. link 7 Roelands M, Deschepper R, Bilsen J. Psychiatric Consultation and Referral of Persons Who Have Attempted Suicide. Crisis 2017. link 8 O'Connor SS, Comtois KA, Atkins DC, Kerbrat AH. Examining the Impact of Suicide Attempt Function and Perceived Effectiveness in Predicting Reattempt for Emergency Medicine Patients. Behavior therapy 2017. link 9 Heinrich RL, Morgan MT, Rottman SJ. Advance directives, preemptive suicide and emergency medicine decision making. Narrative inquiry in bioethics 2011. link 10 Li Y, Zhang J. Serum concentrations of antioxidant vitamins and carotenoids are low in individuals with a history of attempted suicide. Nutritional neuroscience 2007. link 11 Moskop JC, Iserson KV. Emergency physicians and physician-assisted suicide, Part II: emergency care for patients who have attempted physician-assisted suicide. Annals of emergency medicine 2001. link 12 Sweeney KG. A gun-cleaning "accident". Journal of insurance medicine (New York, N.Y.) 2000. link 13 Bautz P, Knottenbelt JD. Successful resuscitation from suicidal hanging: report of three cases. Injury 1994. link90115-5) 14 Bullard MJ. Problems of suicide risk management in the emergency department without fixed, full-time emergency physician. Changgeng yi xue za zhi 1993. link 15 Berman AL, Leenaars AA, McIntosh J, Richman J. Case consultation: Mary Catherine. Suicide & life-threatening behavior 1992. link 16 Kogan Y, Bloom T. Suicidal ligature strangulation with an elastic band. The American journal of forensic medicine and pathology 1990. link 17 Hays P, Bornstein RA. Failed suicide attempt by emission gas poisoning. The American journal of psychiatry 1984. link 18 Rund DA. Attitudes of the emergency physician toward and diagnostic evaluation of suicide attempters. Death education 1984. link 19 Hancock BW, Martin JF, Ward JW, Kilpatrick R. Attempted suicide with a pesticide mixture. Resuscitation 1975. link90033-7)

    Original source

    1. [1]
      The association between vitamin D serum levels, supplementation, and suicide attempts and intentional self-harm. — Lavigne JE, Gibbons JB PloS one (2023)
    2. [2]
      Deliberate Self-Poisoning: Real-Time Characterization of Suicidal Habits and Toxidromes in the Food and Drug Administration Adverse Event Reporting System. — Fusaroli M, Pelletti G, Giunchi V, Pugliese C, Bartolucci M, Necibi EN et al. Drug safety (2023)
    3. [3]
      [Using emergency department routine data for the surveillance of suicide attempts and psychiatric emergencies]. — Schlump C, Thom J, Boender TS, Wagner B, Diercke M, Kocher T et al. Bundesgesundheitsblatt, Gesundheitsforschung, Gesundheitsschutz (2022)
    4. [4]
      A one-year follow-up study of treatment-compliant suicide attempt survivors: relationship of CYP2D6-CYP2C19 and polypharmacy with suicide reattempts. — Peñas-Lledó EM, Guillaume S, de Andrés F, Cortés-Martínez A, Dubois J, Kahn JP et al. Translational psychiatry (2022)
    5. [5]
      Treating Pediatric and Geriatric Patients at Risk of Suicide in General Emergency Departments: Perspectives From Emergency Department Clinical Leaders. — Bowden CF, True G, Cullen SW, Pollock M, Worsley D, Ross AM et al. Annals of emergency medicine (2021)
    6. [6]
      Endogenous cannabinoid levels and suicidality in combat veterans. — Sher L, Bierer LM, Flory J, Hill MN, Makotkine I, Yehuda R Psychiatry research (2020)
    7. [7]
      Psychiatric Consultation and Referral of Persons Who Have Attempted Suicide. — Roelands M, Deschepper R, Bilsen J Crisis (2017)
    8. [8]
      Examining the Impact of Suicide Attempt Function and Perceived Effectiveness in Predicting Reattempt for Emergency Medicine Patients. — O'Connor SS, Comtois KA, Atkins DC, Kerbrat AH Behavior therapy (2017)
    9. [9]
      Advance directives, preemptive suicide and emergency medicine decision making. — Heinrich RL, Morgan MT, Rottman SJ Narrative inquiry in bioethics (2011)
    10. [10]
      Serum concentrations of antioxidant vitamins and carotenoids are low in individuals with a history of attempted suicide. — Li Y, Zhang J Nutritional neuroscience (2007)
    11. [11]
      Emergency physicians and physician-assisted suicide, Part II: emergency care for patients who have attempted physician-assisted suicide. — Moskop JC, Iserson KV Annals of emergency medicine (2001)
    12. [12]
      A gun-cleaning "accident". — Sweeney KG Journal of insurance medicine (New York, N.Y.) (2000)
    13. [13]
      Successful resuscitation from suicidal hanging: report of three cases. — Bautz P, Knottenbelt JD Injury (1994)
    14. [14]
      Problems of suicide risk management in the emergency department without fixed, full-time emergency physician. — Bullard MJ Changgeng yi xue za zhi (1993)
    15. [15]
      Case consultation: Mary Catherine. — Berman AL, Leenaars AA, McIntosh J, Richman J Suicide & life-threatening behavior (1992)
    16. [16]
      Suicidal ligature strangulation with an elastic band. — Kogan Y, Bloom T The American journal of forensic medicine and pathology (1990)
    17. [17]
      Failed suicide attempt by emission gas poisoning. — Hays P, Bornstein RA The American journal of psychiatry (1984)
    18. [18]
      Attitudes of the emergency physician toward and diagnostic evaluation of suicide attempters. — Rund DA Death education (1984)
    19. [19]
      Attempted suicide with a pesticide mixture. — Hancock BW, Martin JF, Ward JW, Kilpatrick R Resuscitation (1975)
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