From the Guidelines
Bowel perforation is a serious medical emergency that requires immediate medical attention, and treatment typically involves hospitalization, intravenous antibiotics, fluid resuscitation, and emergency surgery to repair the perforation and clean the abdominal cavity 1.
Symptoms and Diagnosis
Symptoms of bowel perforation include severe abdominal pain, rigid abdomen, fever, nausea, vomiting, and signs of shock. The diagnosis of bowel perforation is based on clinical, laboratory, and radiologic findings, including abdominal radiographs, ultrasound, and computed tomography (CT) scan with contrast enhancement 1.
Treatment Options
Treatment options for bowel perforation depend on the size and location of the perforation, the patient's general status, and the presence of any underlying conditions. Conservative treatment with broad-spectrum antibiotics and bowel rest may be suitable for small, sealed-off perforations, while surgical treatment is usually required for larger perforations or those with signs of peritonitis 1.
Surgical Treatment
Surgical treatment for bowel perforation typically involves a laparotomy or laparoscopic procedure to close the perforation or create a temporary ostomy. The choice of surgical procedure depends on the size and location of the perforation, as well as the patient's overall health status 1.
Antibiotic Therapy
Antibiotic therapy is an essential part of the treatment for bowel perforation, and broad-spectrum antibiotics such as piperacillin-tazobactam, metronidazole, and gentamicin are commonly used 1. The duration of antibiotic therapy typically ranges from 3 to 7 days, depending on the patient's response to treatment and the presence of any underlying conditions 1.
Recovery and Complications
Recovery from bowel perforation requires close monitoring for complications like sepsis, abscess formation, or peritonitis. Patients should be closely observed for signs of infection, such as fever, abdominal pain, or leukocytosis, and antibiotic therapy should be adjusted accordingly 1.
From the Research
Bowel Perforation Overview
- Bowel perforation is a serious condition that requires prompt diagnosis and treatment 2
- The approach to diagnosis and treatment of bowel perforation is debatable, with some studies suggesting that urgent surgery may not always be necessary 2
Diagnosis of Bowel Perforation
- Physical signs, laboratory findings, and computed tomographic scans can be used to diagnose bowel perforation, but may not always be specific or sensitive 2
- Diagnostic peritoneal lavage can provide high sensitivity and specificity rates for the diagnosis of small bowel perforation if a specially designed positive criterion is applied 2
Treatment of Bowel Perforation
- Delay in surgery for more than 24 hours can increase complications, hospital stay, and time to resume oral intake 2
- The principle of "rushing to the operation suite" for stable blunt abdominal trauma patients without detailed systemic examination is not justified 2
- Surgical intervention is often employed in the management of colonoscopic perforations, with primary repair being the predominant surgical intervention 3
Antibiotic Therapy for Bowel Perforation
- Ceftriaxone and metronidazole can be used as empirical therapy for managing complicated intra-abdominal infection, including bowel perforation 4
- However, a significant proportion of antibiotic-resistant organisms can be identified in cases of perforated bowel and sigmoid diverticulitis, and broader spectrum antimicrobial therapy may be necessary 4
- Ceftriaxone and metronidazole have been shown to be associated with decreased rates of surgical site infections in elective colon surgery 5
- Ceftriaxone and metronidazole have been found to be non-inferior to piperacillin/tazobactam for the treatment of complicated diverticulitis 6