Bowel Perforation
A full-thickness breach of the gut wall spills gas and enteric contents into a sterile cavity, so chemical irritation is followed by bacterial peritonitis and sepsis.
Definition
A full-thickness defect in the wall of the gastrointestinal tract that allows luminal gas or contents to enter the peritoneal, retroperitoneal or adjacent tissue space. Contamination is either walled off by the omentum and adjacent organs, giving a localised inflammatory mass or abscess, or it is not, giving generalised peritonitis. That distinction, not the site of the hole, drives the treatment.
First principles
A breach converts a contained lumen into an infected compartment
A full-thickness defect lets gas, acid, bile, enzymes and enteric bacteria escape into the peritoneal or retroperitoneal space. The omentum and adjacent organs may seal a small leak and wall it off as an abscess. A larger or uncontained leak produces generalised chemical then bacterial peritonitis. The signs follow the contamination, not the size of the hole. Peritonitis is absent in about a third of perforated peptic ulcers, so a soft abdomen never rules a perforation out.
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