A Guide to Bowel Perforation

Medically Reviewed By Kelsey Trull, PA-C
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A bowel perforation is a hole in either the small intestine or large intestine. The hole can be a cut, tear, puncture, or rupture. This hole allows intestinal contents to spill into the abdominal cavity. Intestinal contents from the lower small intestine and the colon contain bacteria. The peritoneal cavity has a lining that completely encloses the area between the diaphragm and the pelvis.

When bacteria enter this contained space, a serious infection called peritonitis can develop. Intestinal perforation, intestinal rupture, and perforated bowel are other names for this condition.

Read on to learn more about bowel perforation, why it happens, and what symptoms it can cause. This article will also cover when to seek emergency medical attention and what treatment options are available for people with bowel perforation.

What causes a bowel perforation?

a woman is in hospital sat by a window
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There are three main causes of a perforated bowel:

  • breakdown of the intestinal wall due infection, inflammation, or disease
  • increased pressure inside the intestine that weakens the intestinal wall
  • trauma or direct injury to the intestinal wall


The most common form of bowel perforation trauma is an accidental injury to the intestine during abdominal surgery. Sometimes, the nick or cut is obvious and the surgeon can repair it during surgery. Other times, it may go unnoticed until symptoms develop after surgery.

Perforation after bowel surgery can also occur when stitches or staples fail to keep the wound closed.

Other forms of trauma can include a severe blow to the abdomen, a knife or gunshot wound, or swallowing a foreign object or caustic agent.

Several conditions can result in increased pressure on or breakdown of the intestinal wall.

Conditions and infections

Conditions and infections that can cause bowel perforation include:

Visit our video center on inflammatory bowel disease here.

What are the symptoms of a bowel perforation?

Symptoms of a perforated bowel tend to develop gradually and worsen over time. It can be difficult to recognize when perforation has happened because it usually occurs due to a condition that is already painful and causing other symptoms.

Bowel perforation symptoms can include:

Serious symptoms that might indicate a life threatening condition

A perforated bowel is a medical emergency. Left untreated, it can quickly lead to sepsis, organ failure, shock, and even death. The acronym “TIME” can tell you when to call 911 or seek emergency medical care for potential sepsis:

temperature, which
may be higher or lower
than expected
infectionmental decline, being
confused, sleepy, or
difficult to rouse
extremely ill, severe pain
or discomfort, shortness
of breath
, difficulty breathing

With sepsis, the risk of mortality increases with each hour treatment is delayed. Timely care is crucial.

Pain with a perforated bowel may start a few days before the hole develops. If you have persistent abdominal pain, contact your doctor promptly.

What are the risk factors for a bowel perforation?

The risk factors for a perforated bowel are related to the three main causes. You are at risk of a bowel perforation if you have any of the following:

Reducing your risk of a bowel perforation

It is not always possible to prevent a bowel perforation.

However, abdominal pain can start a few days before perforation occurs. If you have persistent, unexplained abdominal pain, contact your doctor as soon as possible or seek prompt medical care.

If someone has ingested a caustic substance or a foreign object, call 911 and do not wait for symptoms to develop.

If you have a chronic condition, such as IBD or frequent diverticulitis attacks, it can weaken the intestinal wall. Effectively managing these conditions can help prevent perforations.

How do doctors diagnose a bowel perforation?

If you develop symptoms soon after abdominal or bowel surgery, your doctor may suspect a bowel perforation. If you have not had recent surgery, your doctor will ask about your medical conditions and medical history.

After a physical exam, your doctor may order blood tests to look for signs of infection or blood loss.

In addition, imaging exams can be helpful for diagnosing a bowel perforation. When a hole occurs in the intestine, air and digestive contents enter the peritoneal cavity. Imaging exams, such as an X-ray or ultrasound, can reveal these pockets of air and fluid.

Doctors may also need to use CT scans or MRIs to find the hole. A healthcare professional may inject you with contrast dye to see the perforation more clearly.

In some cases, a diagnostic procedure such as a colonoscopy may be necessary to locate the tear.

What are the treatments for a bowel perforation?

The goals of treatment are to stop the intestinal contents from entering the abdomen and to treat any infection.

In most cases, this means emergency surgery, along with IV, or intravenous, antibiotics and fluids.

The type of surgery depends on the size, location, and cause of the hole. Doctors may be able to repair small tears without any other procedures.

Larger tears may require an ostomy or the removal of part of the intestine to allow the intestine to heal.

An ostomy is an opening through the abdominal wall that allows intestinal contents to exit. A collection bag holds the contents for emptying. The ostomy may be temporary or permanent.

During surgery, the doctor may need to clean out the abdominal cavity and remove infected tissue.

What are the potential complications of a perforated bowel?

A perforated bowel can lead to serious complications, including peritonitis and sepsis. Both of these conditions can quickly become fatal.

Mortality increases dramatically the longer treatment is delayed. In fact, sepsis is fatal for up to 30% of those who have it. It is especially dangerous for the elderly, very young children, and people with chronic medical conditions.

Surgery to repair a perforated bowel is successful in most cases. However, it relies on rapid recognition of a problem and prompt medical care.

Remember TIME (temperature, infection, mental decline, extremely ill), do not delay seeking care, and tell the healthcare professional you are concerned about sepsis. It is better to be mistaken than to increase risk by postponing treatment.

Read a physician’s perspective on Sepsis Awareness Month here.


A bowel perforation is a medical emergency. If it leads to sepsis, it can be fatal.

In some cases, smaller bowel tears can heal on their own. However, it is more likely a person with a bowel perforation will need surgery and treatment to repair it. Therefore, it is important to seek medical attention as soon as possible if you suspect you may have a bowel perforation.

Once a person has received the necessary and appropriate treatment, they usually make a full recovery.


A bowel perforation happens when there is a tear in the intestine. This can allow fluids from the intestine to leak into other parts of the body, including the blood. A bowel perforation is a medical emergency.

Bowel infections can happen from trauma, such as an accident or surgery. It can also happen if something is increasing the pressure in the bowel, for example, a condition such as diverticulitis.

Treatment for a bowel perforation usually involves surgery. The sooner a person with a bowel perforation receives treatment, the better their outcome will be.

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Medical Reviewer: Kelsey Trull, PA-C
Last Review Date: 2022 Mar 29
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