Mechanical bowel perforation

Mechanical bowel perforation is a relatively uncommon occurrence.

Bowel perforation redirects to this article. This article covers the differential diagnosis of bowel perforation.

General

• Uncommon.

Causes of perforation

Non-mechanical causes:

• Inflammatory bowel disease - Crohn's disease, toxic megacolon.
• Diverticular disease.
• Malignancy - see tumour perforation in colorectal cancer.
• Ischemia.
  • Ischemic enteritis.
  • Ischemic colitis.
• Duodenal ulcer.

Mechanical causes:

• Iatrogenic, e.g. complication of a surgery, colonscopy.
  • Typically elderly.
• Trauma, e.g. gunshot wound, sharp force trauma.
  • Typically younger people that were "minding their own business".
• Foreign body.

Gross

• Fibrinous exudate.
• Bowel wall thickening, focal.
• Perforation - may or may not be obvious.

Radiology:

• Free air.

Microscopic

Features:

• Microabscess formation - esp. at serosal aspect.
• Serositis.

DDx:

• Malignancy:
  • Adenocarcinoma, primary.
    • Signet ring cell carcinoma.
  • Metastatic carcinoma.
  • Others.
• Other causes of small bowel obstruction.

Sign out

ILEUM, BOWEL RESECTION:
- SMALL BOWEL WITH FOCAL TRANSMURAL INFLAMMATION, EDEMA, SEROSITIS AND EARLY 
  MICROABSCESS FORMATION -- COMPATIBLE WITH PERFORATION.
- FIBROUS ADHESIONS.
- ONE BENIGN LYMPH NODE.
- NEGATIVE FOR MALIGNANCY.

See also

• Small intestine.
• Colon.
• Tumour perforation in colorectal cancer.