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Copyright (c) 2025 Naif Mohamed Almutairi, Saaed Abdullah Mohammed ALqahtani, Saad Mohammed Saad Lajhar, Fysal Mohammed Saeed ALshahrani, Fares Mohammad Saleh ALqahtani, Muteb Abdullah Mohammad Alqahtani, Mariam Mohamed Saad ALshahrany, Kother Saeed Alsomali
This work is licensed under a Creative Commons Attribution 4.0 International License.
Multidisciplinary Management and Clinical Outcomes of Bowel Perforation in Hospital and Prehospital Settings: Nursing, Pharmacy, Anesthesia, and Emergency Care Perspectives-An Updated Review
Corresponding Author(s) : Naif Mohamed Almutairi
Saudi Journal of Medicine and Public Health,
Vol. 2 No. 2 (2025)
Abstract
Background: Bowel perforation is a life-threatening gastrointestinal emergency characterized by a full-thickness defect in the intestinal wall, allowing leakage of intraluminal contents into the peritoneal cavity. This condition rapidly progresses to peritonitis, sepsis, and multiorgan dysfunction, requiring urgent multidisciplinary management.
Aim: This review aims to synthesize updated evidence on the etiology, epidemiology, clinical presentation, diagnostic modalities, and multidisciplinary management of bowel perforation across hospital and prehospital settings.
Methods: A comprehensive review of current literature was conducted to summarize pathophysiology, risk factors, clinical assessment, imaging strategies, treatment options, and prognostic indicators associated with bowel perforation. Content was organized into thematic sections including etiology, epidemiology, diagnosis, management, and complications.
Results: Bowel perforation arises from inflammatory, infectious, neoplastic, iatrogenic, traumatic, or ischemic mechanisms with etiologies differing between the upper and lower gastrointestinal tract. Its incidence varies by age, with necrotizing enterocolitis predominating in neonates and appendicitis, trauma, diverticulitis, peptic ulcer disease, malignancy, and iatrogenic injury contributing in older populations. Diagnosis relies on clinical assessment supported by laboratory abnormalities and CT imaging as the gold standard. Management requires rapid resuscitation, broad-spectrum antibiotics, and timely surgical intervention, with nonoperative strategies reserved for stable patients with contained perforations. Prognosis depends on comorbidities, perforation severity, and timeliness of recognition.
Conclusion: Effective management of bowel perforation requires early detection, rapid stabilization, interdisciplinary coordination, and appropriate operative or conservative treatment strategies. Improved outcomes depend on timely intervention, optimized postoperative care, and comprehensive management of underlying etiologies.
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- Long B, Robertson J, Koyfman A. Emergency Medicine Evaluation and Management of Small Bowel Obstruction: Evidence-Based Recommendations. J Emerg Med. 2019 Feb;56(2):166-176.
- Ugwu AU, Kerins N, Malik M. Traumatic small bowel perforation in a case of a perineal hernia. J Surg Case Rep. 2018 Dec;2018(12):rjy330.
- Rich BS, Dolgin SE. Necrotizing Enterocolitis. Pediatr Rev. 2017 Dec;38(12):552-559.
- Huang P, Luo N, Shi X, Yan J, Huang J, Chen Y, Du Z. Risk factor analysis and nomogram prediction model construction for NEC complicated by intestinal perforation. BMC Pediatr. 2024 Feb 27;24(1):143.
- Staab V, Naganathan S, McGuire M, Pinto JM, Pall H. Gastrointestinal Perforation with Blunt Abdominal Trauma in Children. Children (Basel). 2024 May 21;11(6)
- Tan SS, Wang K, Pang W, Wu D, Peng C, Wang Z, Zhang D, Chen Y. Etiology and surgical management of pediatric acute colon perforation beyond the neonatal stage. BMC Surg. 2021 Apr 26;21(1):212.
- Onur MR, Akpinar E, Karaosmanoglu AD, Isayev C, Karcaaltincaba M. Diverticulitis: a comprehensive review with usual and unusual complications. Insights Imaging. 2017 Feb;8(1):19-27.
- Behrman SW. Management of complicated peptic ulcer disease. Arch Surg. 2005 Feb;140(2):201-8.
- Makkar R, Bo S. Colonoscopic perforation in inflammatory bowel disease. Gastroenterol Hepatol (N Y). 2013 Sep;9(9):573-83.
- Parray FQ, Wani ML, Malik AA, Wani SN, Bijli AH, Irshad I, Nayeem-Ul-Hassan Ulcerative colitis: a challenge to surgeons. Int J Prev Med. 2012 Nov;3(11):749-63.
- Werbin N, Haddad R, Greenberg R, Karin E, Skornick Y. Free perforation in Crohn's disease. Isr Med Assoc J. 2003 Mar;5(3):175-7.
- Dhadlie S, Mehanna D, McCourtney J. Pneumatosis intestinalis a trap for the unwary: Case series and literature review. Int J Surg Case Rep. 2018;53:214-217.
- Foran AT, Nason GJ, Rohan P, Keane GM, Connolly S, Hegarty N, Galvin D, O’Malley KJ. Iatrogenic Bowel Injury at Exchange of Supra-Pubic Catheter. Ir Med J. 2018 Apr 19;111(4):737.
- Cirocchi R, Duro F, Avenia S, Capitoli M, Tebala GD, Allegritti M, Cirillo B, Brachini G, Sapienza P, Binda GA, Mingoli A, Fedeli P, Nascimbeni R. Guidelines for the Treatment of Abdominal Abscesses in Acute Diverticulitis: An Umbrella Review. J Clin Med. 2023 Aug 25;12(17)
- Ruscelli P, Renzi C, Polistena A, Sanguinetti A, Avenia N, Popivanov G, Cirocchi R, Lancia M, Gioia S, Tabola R. Clinical signs of retroperitoneal abscess from colonic perforation: Two case reports and literature review. Medicine (Baltimore). 2018 Nov;97(45):e13176.
- Cappell MS. Universal lessons learned by a gastroenterologist from a deaf and mute patient: the importance of nonverbal communication and establishing patient rapport and trust. Am Ann Deaf. 2009 Summer;154(3):274-6.
- Sullivan BJ, Kim GJ, Sara G. Treatment dilemma for survivors of rituximab-induced bowel perforation in the setting of post-transplant lymphoproliferative disorder. BMJ Case Rep. 2018 Dec 13;11(1)
- Guzman-Pruneda FA, Husain SG, Jones CD, Beal EW, Porter E, Grove M, Moffatt-Bruce S, Schmidt CR. Compliance with preoperative care measures reduces surgical site infection after colorectal operation. J Surg Oncol. 2019 Mar;119(4):497-502.
- Peacock O, Yanni F, Kuryba A, Cromwell D, Lockwood S, Anderson I, Vohra RS., NELA Project Team. Failure to rescue patients after emergency laparotomy for large bowel perforation: analysis of the National Emergency Laparotomy Audit (NELA). BJS Open. 2021 Jan 08;5(1)
- Li S, Cheng L, Li Y, Ning L, Yu Z, Wang P, Zhou X, Ren J. [Analysis of high risk factors for acute complex appendicitis in adults]. Zhonghua Wei Chang Wai Ke Za Zhi. 2018 Dec 25;21(12):1374-1379.
- Hsu TC, Huang TM, Yang YC. A surgeon's help with the management of bowel problems related to gynecology is truly needed - comparison of two periods spanning 24 years. Taiwan J Obstet Gynecol. 2012 Dec;51(4):612-5.
References
Long B, Robertson J, Koyfman A. Emergency Medicine Evaluation and Management of Small Bowel Obstruction: Evidence-Based Recommendations. J Emerg Med. 2019 Feb;56(2):166-176.
Ugwu AU, Kerins N, Malik M. Traumatic small bowel perforation in a case of a perineal hernia. J Surg Case Rep. 2018 Dec;2018(12):rjy330.
Rich BS, Dolgin SE. Necrotizing Enterocolitis. Pediatr Rev. 2017 Dec;38(12):552-559.
Huang P, Luo N, Shi X, Yan J, Huang J, Chen Y, Du Z. Risk factor analysis and nomogram prediction model construction for NEC complicated by intestinal perforation. BMC Pediatr. 2024 Feb 27;24(1):143.
Staab V, Naganathan S, McGuire M, Pinto JM, Pall H. Gastrointestinal Perforation with Blunt Abdominal Trauma in Children. Children (Basel). 2024 May 21;11(6)
Tan SS, Wang K, Pang W, Wu D, Peng C, Wang Z, Zhang D, Chen Y. Etiology and surgical management of pediatric acute colon perforation beyond the neonatal stage. BMC Surg. 2021 Apr 26;21(1):212.
Onur MR, Akpinar E, Karaosmanoglu AD, Isayev C, Karcaaltincaba M. Diverticulitis: a comprehensive review with usual and unusual complications. Insights Imaging. 2017 Feb;8(1):19-27.
Behrman SW. Management of complicated peptic ulcer disease. Arch Surg. 2005 Feb;140(2):201-8.
Makkar R, Bo S. Colonoscopic perforation in inflammatory bowel disease. Gastroenterol Hepatol (N Y). 2013 Sep;9(9):573-83.
Parray FQ, Wani ML, Malik AA, Wani SN, Bijli AH, Irshad I, Nayeem-Ul-Hassan Ulcerative colitis: a challenge to surgeons. Int J Prev Med. 2012 Nov;3(11):749-63.
Werbin N, Haddad R, Greenberg R, Karin E, Skornick Y. Free perforation in Crohn's disease. Isr Med Assoc J. 2003 Mar;5(3):175-7.
Dhadlie S, Mehanna D, McCourtney J. Pneumatosis intestinalis a trap for the unwary: Case series and literature review. Int J Surg Case Rep. 2018;53:214-217.
Foran AT, Nason GJ, Rohan P, Keane GM, Connolly S, Hegarty N, Galvin D, O’Malley KJ. Iatrogenic Bowel Injury at Exchange of Supra-Pubic Catheter. Ir Med J. 2018 Apr 19;111(4):737.
Cirocchi R, Duro F, Avenia S, Capitoli M, Tebala GD, Allegritti M, Cirillo B, Brachini G, Sapienza P, Binda GA, Mingoli A, Fedeli P, Nascimbeni R. Guidelines for the Treatment of Abdominal Abscesses in Acute Diverticulitis: An Umbrella Review. J Clin Med. 2023 Aug 25;12(17)
Ruscelli P, Renzi C, Polistena A, Sanguinetti A, Avenia N, Popivanov G, Cirocchi R, Lancia M, Gioia S, Tabola R. Clinical signs of retroperitoneal abscess from colonic perforation: Two case reports and literature review. Medicine (Baltimore). 2018 Nov;97(45):e13176.
Cappell MS. Universal lessons learned by a gastroenterologist from a deaf and mute patient: the importance of nonverbal communication and establishing patient rapport and trust. Am Ann Deaf. 2009 Summer;154(3):274-6.
Sullivan BJ, Kim GJ, Sara G. Treatment dilemma for survivors of rituximab-induced bowel perforation in the setting of post-transplant lymphoproliferative disorder. BMJ Case Rep. 2018 Dec 13;11(1)
Guzman-Pruneda FA, Husain SG, Jones CD, Beal EW, Porter E, Grove M, Moffatt-Bruce S, Schmidt CR. Compliance with preoperative care measures reduces surgical site infection after colorectal operation. J Surg Oncol. 2019 Mar;119(4):497-502.
Peacock O, Yanni F, Kuryba A, Cromwell D, Lockwood S, Anderson I, Vohra RS., NELA Project Team. Failure to rescue patients after emergency laparotomy for large bowel perforation: analysis of the National Emergency Laparotomy Audit (NELA). BJS Open. 2021 Jan 08;5(1)
Li S, Cheng L, Li Y, Ning L, Yu Z, Wang P, Zhou X, Ren J. [Analysis of high risk factors for acute complex appendicitis in adults]. Zhonghua Wei Chang Wai Ke Za Zhi. 2018 Dec 25;21(12):1374-1379.
Hsu TC, Huang TM, Yang YC. A surgeon's help with the management of bowel problems related to gynecology is truly needed - comparison of two periods spanning 24 years. Taiwan J Obstet Gynecol. 2012 Dec;51(4):612-5.