Bowel Perforation

Causes include peptic ulcers that erode through the stomach or duodenal wall, diverticulitis (infected pouches in the colon), severe appendicitis, bowel obstruction, severe colitis, tumours, injury to the abdomen, swallowed sharp objects or magnets, and rarely complications of endoscopy or surgery. Anti-inflammatory painkillers, steroids, and a weakened immune system raise the risk.

Bowel perforation is not common, but it is one of the most serious abdominal emergencies. It is more likely in people with certain underlying problems and after some procedures, though the overall chance with procedures such as endoscopy is low.

Doctors examine the abdomen and take blood tests. A chest or abdominal X-ray may show air under the diaphragm. A CT scan is the most accurate test and usually shows the site and cause of the hole. Diagnosis must be fast, and treatment often begins while tests are done.

This is an emergency with no home treatment.

• Call emergency services or go to the nearest ER immediately.

• Do not eat, drink, or take painkillers, laxatives or enemas while waiting.

• Do not drive yourself.

• After recovery, follow your surgeon's activity and wound-care advice.

Nothing by mouth until the medical team says otherwise.

• You will receive fluids through a vein, and sometimes a tube in the stomach to keep it empty.

• Nutrition support through a vein may be used if you cannot eat for some time.

• Food is reintroduced slowly after surgery, guided by the team and a dietitian.

Drugs support surgery; they do not replace it.

• Intravenous antibiotics to treat or prevent infection in the abdomen.

• Intravenous fluids and pain relief.

• Acid-lowering medicine if an ulcer is the cause, and H. pylori treatment later if present.

• Avoid anti-inflammatory painkillers (NSAIDs) after an ulcer perforation unless your doctor approves.

Most perforations need an operation.

• Surgery repairs the hole or removes the damaged segment of bowel and washes out the abdomen.

• A temporary or permanent stoma (a bowel opening on the abdomen) is sometimes needed.

• Small, contained perforations in selected, stable patients may be managed with antibiotics, fasting and close observation, or an endoscopic clip, under specialist care.

• Intensive care may be needed after surgery for very ill patients.

Perforation is dangerous, and the outcome depends on how quickly it is treated, the site of the hole and the patient's overall health. Early surgery and antibiotics lead to better results. Older people and those with other illnesses are at higher risk of complications, so do not wait.

• What caused the perforation in my case?

• Will I need a stoma, and will it be temporary?

• How long is the recovery and when can I go back to normal activities?

• Which medicines should I avoid in future?

• What symptoms after discharge should bring me back immediately?

This guide comes from the Saudi Gastroenterology Association (SGA) patient library, prepared by the Approved for publication by SGA; individual clinician review is ongoing. Last reviewed: 2026-04-24. It is for education and does not replace your doctor's advice.