Explains India’s Top Laparoscopic Surgeon Dr Amita Jain
Gastrointestinal perforation is a medical emergency that requires prompt diagnosis and immediate treatment. The chosen treatment approach typically involves surgical intervention, but the specific course of action may vary depending on the location and severity of the perforation, the patient’s overall health, and other factors says Dr Amita Jain.
What is Gastrointestinal Perforation?
A gastrointestinal perforation occurs when there is a rupture or hole in any part of the gastrointestinal tract, which includes the esophagus, stomach, small intestine, and large intestine (colon). This rupture allows the contents of the digestive system, including stomach acid and partially digested food, to leak into the abdominal cavity. This can lead to a range of complications, including infection, sepsis, and peritonitis, which can be life-threatening if left untreated.
What are the Signs and Symptoms of Gastrointestinal Perforation?
- Severe Abdominal Pain: One of the most common and prominent symptoms of gastrointestinal perforation is intense abdominal pain. This pain is often sudden and excruciating, and it may be localized or diffuse, depending on the location of the perforation.
- Rigidity and Tenderness: The abdominal area may become rigid and extremely tender to the touch. This is often a sign of peritonitis, which is inflammation of the peritoneum, the lining of the abdominal cavity.
- Nausea and Vomiting: Individuals with gastrointestinal perforation may experience persistent nausea and vomiting, which can be especially concerning if there is blood in the vomit.
- Fever and Chills: The presence of an infection in the abdominal cavity can lead to a fever, often accompanied by chills. This fever is typically of a high grade and may not respond to over-the-counter fever-reducing medications.
- Change in Bowel Movements: Depending on the location of the perforation, there may be a change in bowel habits. This can manifest as diarrhea, constipation, or even the absence of bowel movements altogether.
- Loss of Appetite: People with gastrointestinal perforation often experience a significant loss of appetite and may have difficulty eating or drinking due to severe abdominal pain.
- Bloating and Abdominal Distention: As gas and fluids accumulate in the abdominal cavity, there may be noticeable abdominal bloating and distention.
- Hypotension and Shock: In severe cases, gastrointestinal perforation can lead to low blood pressure (hypotension) and shock, which are life-threatening conditions requiring immediate medical attention.
Treatment for Gastrointestinal Perforation
When diagnosed with gastrointestinal perforation, prompt medical intervention is essential. The treatment approach depends on the severity and location of the perforation, and it may involve one of the following surgical methods:
1. Endoscopic Procedure: In some cases, an endoscopic procedure may be employed. This minimally invasive technique utilizes a camera to guide instruments through the intestines. The advantage of an endoscopic procedure is that it typically does not require incisions.
2. Laparoscopic Surgery: Laparoscopic surgery is another minimally invasive option. A camera is inserted into the abdomen through small incisions to provide visualization. This approach offers the benefit of smaller incisions compared to traditional open surgery.
3. Traditional Open Surgery: In more severe cases or when laparoscopic or endoscopic methods are not suitable, traditional open surgery is performed. This surgical approach involves larger incisions in the abdomen to directly access and repair the perforation.
Additionally, in certain situations, a temporary bypass procedure may be necessary to allow the affected area of the colon to rest. If this procedure is required, here’s how it is typically conducted:
- Creation of a Stoma: The surgeon creates a small opening in the abdominal wall, which is referred to as a stoma.
- Attachment of Intestine or Colon: A segment of the small intestine or colon is attached to the stoma.
- Connection of a Colostomy Bag: A colostomy bag is connected to the exterior of the stoma. This specialized pouch is sealed and discreet, designed to collect stools.
Patients or their caregivers are responsible for emptying the colostomy bag as needed, usually on a daily basis. Once the patient has healed, it is common for the stoma and colostomy bag to be removed by a healthcare provider.
In summary, treatment for gastrointestinal perforation involves surgical intervention tailored to the specific circumstances of the patient. Depending on the severity and location of the perforation, medical professionals may opt for endoscopic procedures, laparoscopic surgery, or traditional open surgery. In certain cases, a temporary bypass procedure with a stoma and colostomy bag may be necessary to facilitate healing, with the ultimate goal of returning the patient to normal digestive function.
Dr Amita Jain is a surgeon with highest degree of professional competence, precision and surgical craftsmanship. Performed all complicated general surgery procedures with in depth knowledge of invasive and few minimal invasive and onco surgical techniques. Underwent special training in trauma, executed various trauma-related complex life-saving neurosurgical procedures, reconstructed injured mangled limbs and performed vascular and reconstructive procedures with critical care.
Dr Amita Jain holds 28 plus years of rich experience in Trauma and General Laparoscopic Surgeries (including Gallbladder stone removal, appendix removal, hernia repair surgery, piles and fissure surgeries). She was the Professor Surgery of at the Army College of Medical Sciences and Base Hospital Delhi Cantt. In 1994 she was commissioned as Surgeon under the United Nations Mission in Congo. From 2020 to 2022, she worked with Bansals Hospital. Currently, Dr Amita Jain is the Senior Consultant, (Speciality: General and Laparoscopic Surgeon) at Artemis Lite Hospital, New Delhi