Back

Perforated Viscus

What Is It, Causes, Symptoms, and More

Author:Ashley Mauldin, MSN, APRN, FNP-BC

Editors:Alyssa Haag,Emily Miao, PharmD

Illustrator:Jillian Dunbar

Copyeditor:David G. Walker


What is a perforated viscus?

A perforated viscus, also known as an intestinal or bowel perforation, is a life-threatening condition that occurs when the wall of the gastrointestinal tract ruptures and the enteric contents leak into the peritoneal cavity (e.g., the space between the abdominal wall and the internal organs), thereby causing severe abdominal pain.  

Is a perforated viscus the same as peritonitis?

A perforated viscus is not the same thing as peritonitis. When a perforated viscus occurs, the contents of the stomach and intestines can leak into the peritoneal cavity, which may subsequently cause peritonitis, characterized by inflammation of the abdominal lining. 

Excited Mo character in scrubs
Join millions of students and clinicians who learn by Osmosis!
Start Your Free Trial

What causes a perforated viscus?

Common causes of perforated viscus include inflammation, infections, malignancy, and trauma as well as bowel ischemia and obstruction. 

Peptic ulcer disease is also a common cause of a perforated viscus. Peptic ulcer disease causes an ulcer, or sore, to occur in the lining of the stomach wall. When left untreated, the ulcer can penetrate through all the layers of the stomach wall and cause a hole, or perforation. A perforated peptic ulcer will allow contents of the stomach to leak out, thereby causing peritonitis, sepsis, or even death. 

What are the signs and symptoms of a perforated viscus?

Signs and symptoms of a perforated viscus include a sudden onset of acute abdominal pain or cramping, nausea, vomiting, chills, fever, and shoulder pain as well as swelling, or bloating, of the abdomen. 

How is a perforated viscus treated and diagnosed?

A perforated viscus is diagnosed through a review of medical history and physical examination as well as laboratory and radiology studies. A physical exam will usually reveal a distended abdomen, decreased or absent bowel sounds, and diffuse abdominal tenderness with the presence of rebound and guarding. Subsequent laboratory tests usually include complete blood count; basic metabolic panel; liver function tests; and inflammatory markers, like C-reactive protein. Radiology studies can include chest radiographs and CT scans of the abdomen and pelvis and are typically used to detect the site of perforation as well as to assess for free air in the diaphragm, also known as a pneumoperitoneum.

A perforated viscus is usually considered to be a medical emergency and sometimes even a surgical emergency; therefore, prompt diagnosis and treatment are necessary. Immediate placement of a large-bore IV is indicated along with delivery of emergency fluid resuscitation and empiric antibiotics, especially if the individual is presenting with symptoms of peritonitis, sepsis, or shock (e.g., fever, tachycardia, confusion, shortness of breath, and an enlarged abdomen). A surgical consultation will usually be initiated for a possible laparoscopic or open laparotomy in order to repair the perforation.

What are the most important facts to know about a perforated viscus?

A perforated viscus, also known as an intestinal or bowel perforation, is a life-threatening condition that occurs when the wall of the gastrointestinal tract ruptures and the enteric contents leak into the peritoneal cavity, thereby causing severe abdominal pain. Common causes of perforated viscus include inflammation, infections, malignancy, and trauma as well as bowel ischemia and obstruction. Peptic ulcer disease is also a common cause of a perforated viscus. It causes an ulcer to occur in the lining of the stomach wall, and when left untreated, the ulcer can penetrate through all the layers of the stomach wall and cause a hole, or perforation. Signs and symptoms of a perforated viscus include a sudden onset of acute abdominal pain, cramping, nausea, vomiting, chills, fever, and swelling (or bloating) of the abdomen. A perforated viscus is diagnosed through history and physical examination as well as laboratory and radiology studies. Once diagnosed, it is usually considered to be a medical emergency and sometimes even a surgical emergency. Immediate placement of a large-bore IV is indicated along with delivery of emergency fluid resuscitation and empiric antibiotics, especially if the individual presented with symptoms of peritonitis, sepsis, or shock. A surgical consultation will also be conducted for a possible laparoscopic or open laparotomy. 

Mo with coat and stethoscope

Want to Join Osmosis?

Join millions of students and clinicians who learn by Osmosis!

Start Your Free Trial

Related links

Anatomy of the abdominal viscera: Innervation of the abdominal viscera
Anatomy of the anterolateral abdominal wall
Peritonitis
Bowel Obstruction
Peptic ulcer disease

Resources for research and reference

Abdominal sounds. In Medlineplus Medical Encyclopedia. Retrieved October 06, 2021, from https://medlineplus.gov/ency/article/003137.htm

Ansari, P. (2021). Acute Abdominal Pain. In Merck Manual Professional Version. Retrieved October 06, 2021, from https://www.merckmanuals.com/professional/gastrointestinal-disorders/acute-abdomen-and-surgical-gastroenterology/acute-abdominal-pain#v890211

Bell, D. Solid and hollow abdominal viscera. In Radiopaedia. Retrieved October 06, 2021, from https://radiopaedia.org/articles/solid-and-hollow-abdominal-viscera?lang=us

Chung, K. T., & Shelat, V. G. (2017). Perforated peptic ulcer - an update. World Journal of Gastrointestinal Surgery, 9(1), 1–12. DOI: 10.4240/wjgs.v9.i1.1

Cutright, A. (2019). Perforated Viscus. In Clerkship Directors in Emergency Medicine. Retrieved October 06, 2021, from https://www.saem.org/about-saem/academies-interest-groups-affiliates2/cdem/for-students/online-education/m4-curriculum/group-m4-gastrointestinal/perforated-viscus

Hafner, J., Tuma, F., & Hoilat, G.J. (2021). Intestinal Perforation. In StatPearls [Internet]. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK538191/

Jones, M.W., Kashyap, S., & Zabbo, C.P. (2021). Bowel Perforation. In StatPearls [Internet]. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK537224/

Lee, S. Bowel perforation. In Canadian Cancer Society.  Retrieved October 06, 2021, from https://cancer.ca/en/treatments/side-effects/bowel-perforation