Gastrointestinal perforation medical therapy

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mohammed Abdelwahed M.D[2] {{

Overview

Initial management of the patient with gastrointestinal perforation includes intravenous (IV) fluid therapy, cessation of oral intake, and broad-spectrum antibiotics. Drainage, gastrostomy, and feeding jejunostomy may be appropriate depending upon the level of the perforation. Monitoring should initially take place in an intensive care unit. The administration of intravenous proton pump inhibitors is appropriate for those suspected to have an upper gastrointestinal perforation. Patients with intestinal perforation can have severe volume depletion. The severity of any electrolyte abnormalities depends upon the nature and volume of material leaking from the gastrointestinal tract. Surgical management of patients with free perforation should be expedited to minimize such derangements. Electrolyte abnormalities are common among those who have developed a fistula as a result of perforation (eg, metabolic alkalosis from gastrocutaneous fistula).