Your colon is composed of layers of smooth muscle and mucous membranes. The innermost layer, called the mucosa, is soft and pliant—similar to the tissues in your mouth. Bowel perforations occur when a hole is made in this lining, usually as a result of surgery or serious bowel disease.
Bowel perforations usually do not occur suddenly, nor in the absence of trauma to your colon. However, some people can develop holes in their intestinal lining, but only if a chronic inflammatory bowel condition is present, such as Crohn’s disease or ulcerative colitis.
Scientists have found that a number of factors may increase your risk of developing a bowel perforation, including:
- Prior abdominal surgery
- Prior pelvic surgery
- Age greater than 75
- History of multiple medical problems
- History of diverticulosis or diverticulitis
- Pelvic adhesions
- Female gender: women typically have a more flexible colon, which can lead to accidental perforation during medical procedures, including a colonoscopy.
How It Occurs
Unless the bowel perforation occurs spontaneously, a form of trauma is needed to create a hole in the colon. A bowel perforation can be a complication—although rare—of several diagnostic procedures, including:
- Enema – An improperly or forcefully inserted rectal tube for an enema can rip or push through the colon lining.
- Sigmoidoscopy – Although the endoscope is flexible, perforation remains a risk, but a rare one.
- Colonoscopy – The tip of the endoscope has the potential to push through the inner lining of the colon, although this is a rare complication of the procedure and is not seen in the virtual colonoscopy.
- Severe bowel obstruction – A serious impaction of stool in the colon (especially a weak colon, such as one with diverticular disease) can cause a tear.
A Medical Emergency
Perforation of the bowel is considered a medical emergency and requires immediate treatment. Left untreated, the contents of the bowel can leak out and cause inflammation, infection and even abscesses in your abdomen. The technical name for this is peritonitis, which is a painful precursor to sepsis—or a body-wide infection. Complications of untreated perforation may include:
- Infection (peritonitis and sepsis)
Symptoms to Report
If you've recently had a medical procedure involving your colon (or you have a history of inflammatory bowel or diverticular disease) and are having undesirable symptoms, call your doctor. He or she can help determine if the symptoms are normal and anticipated, or possibly a herald of something worse, like a perforation. Although fairly general, the following symptoms should be reported to your doctor immediately:
- Rectal bleeding
- Abdominal pain and bloating
- Severe abdominal cramping
- Nausea and vomiting
- Chills and fatigue
- Sudden change in your bowel movements and habits
How It's Found
If your doctor suspects a bowel perforation, he or she can order tests to confirm the suspicion. A simple abdominal x-ray may show gas outside the colon, or your doctor may order a computed tomography (CT) scan of your abdomen to clearly identify it. A blood lab can show an elevated white blood cell count, which is anticipated if bowel contents are leaking into your abdomen.
The majority of perforations are surgically repaired. Depending on the location and size of the tear, the doctor might be able to fix it through an endoscope, similar to the one used during a colonoscopy—but this is not an option for everyone. Open bowel surgery may or may not result in a stoma and colostomy: an artificial opening outside of your stomach where stool drains into a small bag until the bowel is healed.
During your initial recovery period, you will not be able to drink or eat anything by mouth. This is called resting the bowels, and allows the inner lining time to heal properly. You may receive intravenous antibiotics and nutrition for a few days if you're in the hospital. Although you may be anxious to return to your normal routine, it's important that you give your colon time to heal properly, and follow your doctor's orders.
Lohsiriwat, V. (January 2010). Colonoscopic Perforation: Incidence, Risk Factors, Management and Outcome. Accessed September 21, 2012.
Medline Plus. (n.d.). Gastrointestinal Perforation. World Journal of Gastroenterology; 28, (16). Accessed September 21, 2012.
National Cancer Institute. (n.d.). Tests to Detect Colorectal Cancer and Polyps. Accessed September 21, 2012.