Perforated Viscus (Emergency Medicine)

00:02 Hi. We’re gonna be talking about perforated viscus.

00:05 So before we get started, let’s talk about what perforated viscus is.

00:10 So it’s a life threatening cause of abdominal pain and it’s caused by a hole in the wall of the bowel which then leads to a systemic inflammatory response and ultimately sepsis.

00:22 It has a very high mortality.

00:25 Somewhere upwards around 30 to 50%, and requires simultaneous diagnosis, resuscitation and treatment.

00:32 So these are patients who generally are gonna come in, they’re gonna for the most part be looking critically ill and we’re gonna wanna make sure that we recognize this condition in the Emergency Department, we diagnose it rapidly and get the patient appropriate treatment.

00:47 So where is the most common places that the bowel gets a hole in it? Most commonly, it’s related to a perforated peptic ulcer, so due to an ulcer in the stomach that then erodes through the wall of the stomach or diverticulitis.

01:02 It’s very rare for the perforation to be in the small intestine but there are actually a lot of places or a lot of issues that can cause perforated viscus.

01:15 So for example a foreign body.

01:17 If someone ingests a pointy foreign body such as glass or nails which are sometimes done in an attempt for self-harm, that can perforate the bowel wall.

01:27 Another important foreign body to consider and think about would be a button battery in a small child or in an adult for that matter.

01:33 Those are the small tiny batteries that are in hearing aids and other little electronic devices.

01:39 Those can actually be quite caustic.

01:41 They have significantly alkaline solution on the battery and they can really erode actually through the wall of the esophagus or the wall of the stomach.

01:50 So trying to figure out if someone ingested a button battery is a key thing.

01:54 It’s a tiny little thing and you would think it wouldn’t be able to do a lot of harm but it actually can be very, very harmful to the intestines.

02:02 Ischemia is another thing that can cause a hole in the intestinal wall as the bowel wall gets decreased blood flow, it can thin out and then in turn, cause a perforation.

02:14 Obstruction from both extrinsic and intrinsic features.

02:17 Infectious components, diverticulitis is actually an infection.

02:21 Whenever you get infections in the wall of the intestines that can again cause there to be a defect in the wall of the intestines after a period of time.

02:33 And then anything that will decrease the bowel wall integrity.

02:36 Anything that will make that wall weaker and easier for things to go through will go ahead and increase the rates of a perforated viscus.

02:44 Now, let’s talk about peptic ulcer disease as a cause of this for a moment.

02:50 So patients with peptic ulcer disease will experience perforation 2 to 10% of the time.

02:55 So this is something that might not be that uncommon.

02:58 Duodenal ulcers, so that’s an ulcer in the first portion of the small intestine are actually most common to cause perforation with 60%.

03:08 And then antral gastric ulcers and gastric body ulcers are each 20%.

03:14 So duodenal ulcer is the most common thing that’s gonna rupture and then those ulcers that are in the stomach are each 20%.