Perforated Bowel Complications
A perforated bowel can very quickly cause serious, life-threatening complications. Prompt diagnosis and treatment is vital to ensure the survival of the patient.
What is a perforated bowel?
The term 'perforated bowel' (sometimes referred to as a ruptured bowel) refers to a split or hole at some point in the digestive tract. This is most likely to be in the small or large intestine. A perforated bowel requires emergency medical treatment as it will otherwise allow the contents of the bowel to filter into areas of the body such as the abdomen where it can cause serious health problems.
Causes of a perforated bowel
The bowel can be perforated due to both internal and external phenomena.
Internal causes
A pre-existing bowel condition such as diverticulitis, crohn's disease or inflammatory bowel disease may cause inflammation and/or scarring of the intestinal wall. This can lead to a weakening of the bowel, causing a split to occur.
Initial signs of such an occurrence would be pain and swelling of the abdomen along with flu-like symptoms such as a high temperature, nausea and vomiting.
External Causes
A bowel perforation can be caused by a wound to the abdomen due to an accident or physical attack.
It is also possible for a perforated bowel to occur during the course of a surgical procedure such as:
- A colonoscopy examining the colon with a tube inserted via the rectum
- A hysterectomy
Damage to the intestine is a known risk in several forms of abdominal and bowel surgery and patients should be made aware of this. It is not necessarily an indication of medical negligence.
Where such an incident occurs, however, it is vital that the damage is identified and repaired at the time. This would reduce the chances of movement of waste matter into the abdomen, thus making it less likely that the patient will develop complications and prevent the need for subsequent further surgery.
Complications of a perforated bowel
The most likely and serious complication of a perforated bowel is the development of peritonitis if bacteria from the bowel seeps into the peritoneum lining the abdomen. Peritonitis is a medical emergency. The infection may spread into the bloodstream, causing septicaemia which can lead to multiple organ failure and death.
A perforated bowel can also cause surgical or subcutaneous emphysema where air or gas gets into the tissue beneath the skin causing swelling, usually of the chest and neck although it an affect other parts of the body. This can cause swelling and, in itself, can act as an indication that a bowel perforation has occurred.
Responding to a perforated bowel
Diagnosing
Symptoms of a perforated bowel as mentioned above are likely to include pain, swelling and tenderness of the abdomen accompanied by signs of a fever. Where the patient is known to have a relevant pre-existing condition or to have recently undergone abdominal surgery, a prompt diagnosis should be possible.
A CT scan may be necessary to provide further evidence of a bowel perforation and exploratory surgery may be necessary to definitively diagnose and then repair a bowel perforation.
Treating
Once a perforated bowel has been diagnosed, urgent treatment is necessary. The body needs to be protected against possible, severe infection with the administration of intravenous antibiotics.
It is also likely that the damage to the bowel will need to be repaired surgically.
Medical Negligence
A perforated bowel is not necessarily caused by medical negligence. As already stated, it can happen naturally as a result of another condition or as a reasonable effect of surgery unless the damage is thought to have been caused by incompetence or a substandard level of care during surgery.
However, a failure to diagnose a perforated bowel, especially under circumstances where such a diagnosis should be highly likely, the medical practitioner(s) may have been negligent. Where a delay in diagnosis and treatment leads to a poorer outcome for the patient than should otherwise have been expected, the patient may have received a substandard level of care.
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