From the Guidelines
Abdominal perforation is most commonly caused by peptic ulcer disease, appendicitis, and diverticulitis, as well as other conditions such as trauma, iatrogenic causes, ingested foreign bodies, and cancer, which can all lead to a hole in the wall of an organ within the abdominal cavity. The causes of abdominal perforation can be diverse and include:
- Peptic ulcer disease, where stomach acid erodes through the stomach or duodenal wall 1
- Appendicitis, when the appendix becomes inflamed and ruptures 1
- Diverticulitis, where inflamed pouches in the colon wall burst
- Trauma from penetrating injuries like stab wounds or blunt force trauma
- Iatrogenic causes from medical procedures such as endoscopy or colonoscopy 1
- Ingested foreign bodies that pierce the digestive tract
- Cancer that invades through organ walls Inflammatory bowel diseases like Crohn's disease can weaken intestinal walls leading to perforation. Certain medications including NSAIDs, steroids, and chemotherapy drugs increase perforation risk by compromising mucosal integrity 1. Infections like typhoid fever can also cause intestinal perforations. Abdominal perforation represents a medical emergency requiring immediate surgical intervention as it allows intestinal contents to leak into the abdominal cavity, causing peritonitis, sepsis, and potentially death if not treated promptly.
From the Research
Abdominal Perforation Causes
- Peptic ulcer disease (PUD) is a common cause of abdominal perforation, with a lifetime prevalence of perforation in patients with PUD of about 5% 2
- Gastroduodenal perforation may be spontaneous or traumatic, with the majority of spontaneous perforation due to peptic ulcer disease 3
- Helicobacter pylori is a major cause of perforated peptic ulcers 3
- Traumatic appendicitis is a less common cause of abdominal perforation, resulting from direct compression/crush injury, shearing injury, or indirect obstruction of the appendiceal lumen 4
- Other causes of abdominal perforation include intestinal injury and hollow viscus injury following blunt abdominal trauma 5, 4
Risk Factors and Associations
- The incidence of PUD has been estimated at around 1.5% to 3%, with 4 million people worldwide affected annually 2
- Abdominal perforation is a serious complication of PUD, with a mortality rate ranging from 1.3% to 20% 2
- Secondary peritonitis and intra-abdominal sepsis are global health problems that can result from abdominal perforation 6