How is it treated?
Surgical Techniques in GI Perforation
The surgical technique employed varies depending on the pathology and the anatomical location involved. The most important aspect of any surgery for perforation however remains the intra-operative washout
Any peptic ulcer perforation can be accessed typically via an upper midline incision (or laparoscopically if feasible) and a patch of omentum (termed a “Graham patch”) is tacked loosely over the ulcer, which would otherwise be difficult to oversaw due to tissue inflammation
Small bowel perforations can be accessed via a midline laparotomy; small perforations can be overseen if the bowel is viable, yet any doubt about condition of bowel should lead to bowel resection +/- primary anastomosis +/- stoma formation
Large bowel perforations can be accessed via midline laparotomy; anastomosis in the presence of faecal contamination and an unstable patient is not recommended, so a resection with stoma formation is often the preferred option.
Postoperative and Rehabilitation Care
Patients who present early after perforation normally recover well and may be fed a day or two after the operation and discharged once they are tolerated sufficient intake. Patients who present late in a septic state or have multiple comorbidities may have a more protracted recovering including time in the ICU to treat them for their sepsis.