DGIM - Klug entscheiden in der Angiologie

To see contributor disclosures related to this article, hover over this reference: [1] Physicians may earn CME/MOC credit by searching for an answer to a clinical question on our platform, reading content in this article that addresses that question, and completing an evaluation in which they report the question and the impact of what has been learned on clinical practice. <a data-phrasegroup-id="d4coRc0" data-category="bonus" class="api dictionary" data-content="PHA+QSBsZWFybmluZyBhbmQgcmVmZXJlbmNlIHBsYXRmb3JtIGZvciBtZWRpY2FsIHN0dWRlbnRzIGFuZCBjbGluaWNpYW5zLiBPZmZlcnMgYSBjb21wcmVoZW5zaXZlLCBpbnRlcmFjdGl2ZSBRYmFuayBhbmQgTGlicmFyeSBvZiBjb250ZW50IGRldmVsb3BlZCB2aWEgYSByaWdvcm91cyBpbnRlcm5hbCBwZWVyLXJldmlld2VkIHByb3RvY29sIGJ5IG92ZXIgNTAgcGh5c2ljaWFucy4gQU1CT1NTIGlzIG9uIGEgbWlzc2lvbiB0byBlbXBvd2VyIGFsbCBkb2N0b3JzIHRvIHByb3ZpZGUgdGhlIGJlc3QgcG9zc2libGUgY2FyZS48L3A+" id="L80cb5d8a8b635382d5fea8d9c63b635d" data-source="L80cb5d8a8b635382d5fea8d9c63b635d" data-tip="d4coRc0">AMBOSS</a> designates this Internet point-of-care activity for a maximum of 0.5 <a data-phrasegroup-id="MxcMCe0" data-category="bonus" class="api dictionary" data-content="PHA+QW4gYWJicmV2aWF0aW9uIHRoYXQgY2FuIHJlZmVyIHRvOjxicj4NCjEuIEFudGltaXRvY2hvbmRyaWFsIGFudGlib2R5PGJyPg0KMi4gQW50aW1pY3Jvc29tYWwgYW50aWJvZHk8YnI+DQozLiBBbWVyaWNhbiBNZWRpY2FsIEFzc29jaWF0aW9uPGJyPg0KNC4gQWdhaW5zdCBtZWRpY2FsIGFkdmljZTwvcD4=" id="Lbe6d57d821e7667c842d0592fdec3022" data-source="Lbe6d57d821e7667c842d0592fdec3022" data-tip="MxcMCe0">AMA</a> <a data-phrasegroup-id="BsczCd0" data-category="bonus" class="api dictionary" data-content="PGk+QWJicmV2aWF0aW9uOiBQUkE8L2k+PGJyPjxwPkEgbWVhc3VyZSBvZiB0aGUgYWN0aXZpdHkgb2YgcmVuaW4gaW4gdGhlIHNlcnVtLCBnaXZlbiBpbiBuZy9tTC9ob3VyLiBBIFBSQSAmbHQ7IDEgbmcvbUwvaG91ciBpcyBjb25zaWRlcmVkIGxvdy4gVGhlIHJhdGlvIG9mIHBsYXNtYSBhbGRvc3Rlcm9uZSBjb25jZW50cmF0aW9uIChQQUMpIHRvIHBsYXNtYSByZW5pbiBhY3Rpdml0eSAoUFJBKSBpcyB1c2VkIHRvIGV2YWx1YXRlIGZvciBwcmltYXJ5IGFsZG9zdGVyb25pc20uPC9wPg==" id="Laab2b5f6e3cf68394c5a1e96675f802e" data-source="Laab2b5f6e3cf68394c5a1e96675f802e" data-tip="BsczCd0">PRA</a> Category 1 Credit(s)™. Physicians should claim only credit commensurate with the extent of their participation in the activity. For answers to questions about <a data-phrasegroup-id="d4coRc0" data-category="bonus" class="api dictionary" data-content="PHA+QSBsZWFybmluZyBhbmQgcmVmZXJlbmNlIHBsYXRmb3JtIGZvciBtZWRpY2FsIHN0dWRlbnRzIGFuZCBjbGluaWNpYW5zLiBPZmZlcnMgYSBjb21wcmVoZW5zaXZlLCBpbnRlcmFjdGl2ZSBRYmFuayBhbmQgTGlicmFyeSBvZiBjb250ZW50IGRldmVsb3BlZCB2aWEgYSByaWdvcm91cyBpbnRlcm5hbCBwZWVyLXJldmlld2VkIHByb3RvY29sIGJ5IG92ZXIgNTAgcGh5c2ljaWFucy4gQU1CT1NTIGlzIG9uIGEgbWlzc2lvbiB0byBlbXBvd2VyIGFsbCBkb2N0b3JzIHRvIHByb3ZpZGUgdGhlIGJlc3QgcG9zc2libGUgY2FyZS48L3A+" id="L189ac7d47b8ed8f3695d811de56b3177" data-source="L189ac7d47b8ed8f3695d811de56b3177" data-tip="d4coRc0">AMBOSS</a> CME, including how to redeem CME/MOC credit, see "Tips and Links" at the bottom of this article.

CME information and disclosures

Gastrointestinal perforation is a full-thickness loss of bowel wall integrity that results in perforation <a data-phrasegroup-id="Eo08dS" data-category="bonus" class="api dictionary" data-content="PHA+SW5mbGFtbWF0aW9uIG9mIHRoZSBwZXJpdG9uZXVtICh0aGUgaW5uZXIgbGluaW5nIG9mIHRoZSBhYmRvbWluYWwgd2FsbCB0aGF0IGFsc28gY292ZXJzIG1vc3QgaW50ZXJuYWwgb3JnYW5zKSwgdXN1YWxseSBvZiBpbmZlY3Rpb3VzIG9yaWdpbi48L3A+" id="Lbc1255f378bde9a67dfe5df8cd476f21" data-source="Lbc1255f378bde9a67dfe5df8cd476f21" data-tip="Eo08dS">peritonitis</a>. <a data-tip="zKYrQJ" id="L7819a20b31b3dce0adff2ba1256ed254" data-category="link" href="Peptic_ulcer_disease#Zf2a7ff9db9aaeff90987e1a45c33b2db" data-lxid="zg0rB2">Perforation of a duodenal ulcer</a> is the most common cause of perforation <a data-phrasegroup-id="Eo08dS" data-category="bonus" class="api dictionary" data-content="PHA+SW5mbGFtbWF0aW9uIG9mIHRoZSBwZXJpdG9uZXVtICh0aGUgaW5uZXIgbGluaW5nIG9mIHRoZSBhYmRvbWluYWwgd2FsbCB0aGF0IGFsc28gY292ZXJzIG1vc3QgaW50ZXJuYWwgb3JnYW5zKSwgdXN1YWxseSBvZiBpbmZlY3Rpb3VzIG9yaWdpbi48L3A+" id="L7eedadbe52bcf41221920ff0f586736d" data-source="L7eedadbe52bcf41221920ff0f586736d" data-tip="Eo08dS">peritonitis</a>. Patients typically present with an acute onset of severe abdominal <a id="L8e40fbce1fb7a8a143676d0713449b4f" data-category="link" href="Principles_of_pain_management#Zd673a3f7ee36023aab5a267899e984cc" data-lxid="xN0EWg">pain</a> associated with <a href="Nausea_and_vomiting#Z2f0b48ef2acaab783b03e4c8d2404f90" data-category="link" id="L883bc360a814b90d8e5297db40ccd1a3" data-lxid="7J04vS">nausea</a>, <a href="Nausea_and_vomiting#Z2f0b48ef2acaab783b03e4c8d2404f90" data-category="link" id="L967768ecdfbf7feec0fb52118eb58afe" data-lxid="7J04vS">vomiting</a>, and <a data-tip="CL0q-g" href="Fever#Za5de83449ff6a749e6c1348b93b1f3b1" data-category="link" id="L530a49a91c5df9b90080ded0fdca4b34" data-lxid="j50_Pg">fever</a>. Signs of <a data-tip="3SbSzG" id="L2702b743aabf69c6a20075b27617fab9" data-category="link" href="Abdominal_cavity#Z5cade66952c197c29b552666e2f95aef" data-lxid="LJ0wuS">peritoneal</a> irritation are evident on examination and include decreased bowel sounds and diffuse or localized <a data-tip="QdXupC" id="L28dc3cc5b58cf3e431a214754e0f8cb2" data-category="link" href="Abdominal_examination#Z4838ee0ae072cab29985721c1a2457bb" data-lxid="XL09wg">abdominal guarding</a> and <a data-tip="eLcx910" id="La8017f4a0dd76e4ab654a89085ee356b" data-category="link" href="Abdominal_examination#Z49b5ae12aa11e9ea8de3b1c1b9b8fd85" data-lxid="XL09wg">rebound tenderness</a>. CT abdomen with IV contrast is the preferred imaging modality to confirm the presence of free air within the <a data-tip="rkcf6c0" id="L69ff7bff3f6328382d7ab818fc984e7a" data-category="link" href="Abdominal_cavity#Z1087e89dae1dc1a10ab2ae374ba57353" data-lxid="LJ0wuS">peritoneal cavity</a> (<a data-tip="-Q0DAf" id="L57398679dd114298ae58ca896d738c98" data-category="link" href="Laparoscopic_surgery#Ze551b661b6322bbdce64f55404ac0f4f" data-lxid="B50zmg">pneumoperitoneum</a>) and localize the site of the perforated <a data-phrasegroup-id="wdbhHs" data-category="bonus" class="api dictionary" data-content="PHA+QW4gaW50ZXJuYWwgb3JnYW4sIHNwZWNpZmljYWxseSBhbiBvcmdhbiBsb2NhdGVkIHdpdGhpbiB0aGUgYWJkb21lbiBvciBjaGVzdC48L3A+" id="L5a414d7ca9122e167d06e8e0d3747362" data-source="L5a414d7ca9122e167d06e8e0d3747362" data-tip="wdbhHs">viscus</a>. Most patients will require an <a data-tip="bHcHKd0" id="L63ea07704aae390d5790e3069e085baf" data-category="link" href="Penetrating_trauma#Zc96b69a4bc98119557e54087976f34d7" data-lxid="_P05hT">emergency exploratory laparotomy</a>. Patients with evidence of a well-contained perforation (e.g., a small localized appendicular or diverticular perforation) and no <a data-tip="du1oJi0" id="L6def4a652dd9f97d1748402cb5ba32ad" data-category="link" href="Sepsis#Zfc5000635c82df81690cce04f017a9cc" data-lxid="xm0E3g">signs of sepsis</a> may be given a trial of <a data-phrasegroup-id="cdbaKs" data-category="bonus" class="api dictionary" data-content="PHA+QSB0aGVyYXBldXRpYyBzdHJhdGVneSB0aGF0IHNlZWtzIHRvIGF2b2lkIGludmFzaXZlIGFuZC9vciByaXNreSBpbnRlcnZlbnRpb25zLiBFeGFtcGxlcyBpbmNsdWRlIG5vbm9wZXJhdGl2ZSBtYW5hZ2VtZW50IG9mIGNsYXNzaWNhbGx5IHN1cmdpY2FsIGNvbmRpdGlvbnMgYW5kIG1lZGljYWwgdGhlcmFweSBmb2N1c2VkIG9uIHByZXZlbnRpdmUgbWVhc3VyZXMsIHN1cHBvcnRpdmUgY2FyZSwgc3ltcHRvbSBjb250cm9sLCBhbmQgd2F0Y2hmdWwgd2FpdGluZy48L3A+" id="L0d30f212ee33ff847766fa954e9b195c" data-source="L0d30f212ee33ff847766fa954e9b195c" data-tip="cdbaKs">conservative management</a> with <a href="Overview_of_antibiotic_therapy#Z4660f53b2b0c85aa3f9ab01bdf3f14f3" data-category="link" id="L3e69b150e61530b4ad74ba447a475701" data-lxid="mm0VTg">antibiotics</a>, bowel rest, close monitoring of <a data-tip="2LYTCp" id="L608f7c504ab44d9e977b56dd4d9a6579" data-category="link" href="Physical_examination#Z4bddb4371ce536d0b0270ec0582a5d45" data-lxid="HJ0KvS">vital signs</a>, and <a data-phrasegroup-id="7EW4CM0" data-category="bonus" class="api dictionary" data-content="PHA+VGhlIHJlZXhhbWluYXRpb24gb2YgYSBwYXRpZW50J3MgYWJkb21lbiBhdCByZWd1bGFyIGludGVydmFscyAoZS5nLiwgZXZlcnkgNCBob3VycykgYWZ0ZXIgYW4gaW5pdGlhbCAoYmFzZWxpbmUpIGFiZG9taW5hbCBleGFtaW5hdGlvbi4gQ29tbW9ubHkgcGVyZm9ybWVkIGluIHBhdGllbnRzIHdpdGggYWN1dGUgYWJkb21pbmFsIHBhaW4gb3IgdHJhdW1hIHRvIGRldGVybWluZSBpZiB0aGUgcGF0aWVudCdzIGNvbmRpdGlvbiBpcyBzdGFibGUgb3IgZGV0ZXJpb3JhdGluZy48L3A+" id="Lc49b156a58ce9092b5c573a3da3c4a96" data-source="Lc49b156a58ce9092b5c573a3da3c4a96" data-tip="7EW4CM0">serial abdominal examination</a>. The prognosis depends on the etiology, degree of intraabdominal contamination, and other comorbidities. See also <a href="Esophageal_perforation#Z24f399a47dbd11477a0db3fba2ba414d" data-category="link" id="L4a622635a79594862512d32cf2dbafb2" data-lxid="wg0hx2">esophageal perforation</a>.

Summary

<ul>
<li>
Ulcerative/erosive disease [2] <ul>
<li>
<a data-tip="m40VPT" href="Peptic_ulcer_disease#Zff8a777f774160654aae94375bc8ccab" data-category="link" id="L1c358606328ea897eed72e2965ff8fed" data-lxid="zg0rB2">Peptic ulcer disease</a>: <ul>
<li>
Most common cause of <a data-tip="lSXv-x" href="Stomach#Z40cae28d835e21e520b7df1c57365751" data-category="link" id="L7130cb62bdcb71fb308c12f79b4c0587" data-lxid="U60b4S">stomach</a> and <a data-tip="v4cAOc0" id="Lb0931ab564c5f0455f075500e8fb91d1" data-category="link" href="Small_intestine#Z9920987de758b4f042fe199e624f79df" data-lxid="eJ0xGS">duodenal</a> perforation <span class="api explanation" data-category="bonus" data-content="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" id="E43e33d296856c8e359e1dbc4be0df7fd" data-tip=" ">[3]
</li> <li>
<a data-tip="DLb1-8" id="L79d7d4013cb4e725ec332e89eae35ef7" data-category="link" href="Peptic_ulcer_disease#Zf63420027bdc211e95be3431cf1a5d59" data-lxid="zg0rB2">Duodenal ulcers</a> of the <a id="L9de7039080c89ab6938485979a2579c2" data-category="link" href="Anatomical_terms#Z611d380c96ce797875c8e46c949415ed" data-lxid="xo0EVS">anterior</a> wall are more likely to perforate. <span class="api explanation" data-category="bonus" data-content="TGVzcyBwcm90ZWN0aW9uIGlzIHByb3ZpZGVkIGJ5IHRoZSBzdXJyb3VuZGluZyBhbmF0b21pY2FsIHN0cnVjdHVyZXMuCg==" id="Ef18b0c2bb399a348c374d4eae8cb212a" data-tip=" ">
</li> </ul>
</li> <li class="condensed-hidden-step1">
<a data-tip="OHXIqz" id="Lba5b06a7962b32f452d20500a63ee4b9" data-category="link" href="General_oncology#Z8c3bce39ca977e0f872b6d9fb3be8cfb" data-lxid="WM0Png">Malignancy</a> <span class="api explanation" data-category="bonus" data-content="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" id="Eb16a433f5be790d4f4e8c58a163eaa7e" data-tip=" ">
</li> <li class="condensed-hidden-step1">
<a data-tip="Wj0Pzf" id="L2cbf855c5ca32dbffe947262f4aae447" data-category="link" href="Crohn_disease#Z4272f924349255b3e4babe86d4e939c9" data-lxid="VS0GA2">Inflammatory bowel disease</a>: <a data-tip="r40fkT" href="Ulcerative_colitis#Zbb0aec0a5fe14ad0aae10a9341c457fc" data-category="link" id="L3f9033b107b6e928d96d6175e3328c21" data-lxid="eS0xA2">ulcerative colitis</a>, <a data-tip="I40YkT" href="Crohn_disease#Zef70853af5e87c95d210bf8df682f64c" data-category="link" id="L48dc0e5d16f2774ca9abcc57e29153bd" data-lxid="VS0GA2">Crohn disease</a> 
</li> </ul>
</li> <li class="condensed-hidden">
Infections <ul>
<li>
<a data-tip="DF0143" href="Diverticulitis#Z37e56210feb49190218cb62dd1e5b2cd" data-category="link" id="Le9c7bc7a658cc68436d513eb13f712b8" data-lxid="_H05Gh">Diverticulitis</a> (<a data-tip="n1b7hs" href="Diverticulosis#Z2bd4ceaa949a576abb48eb53cfd2a5c3" data-category="link" id="L005b884ebea848a7b5369e52d6bad1a2" data-lxid="1S02A2">colonic diverticula</a>, <a data-tip="Oy0I2i" href="Meckel_diverticulum#Z18c0173da16e6a60a949999550965e0d" data-category="link" id="L559009a50bb9538f8eea4d6a2bfe15d1" data-lxid="3o0SbS">Meckel diverticulum</a>)</li> <li><a data-tip="bO0HIT" href="Acute_appendicitis#Z63ef125493d91a6f2662805f10623675" data-category="link" id="L91a9c2c5f51b33d5ad14da4153c72a1f" data-lxid="a30QSf">Acute appendicitis</a></li> <li>
<a data-tip="tycXSU0" id="Ld064fe301d6c4153c0802571995563ce" data-category="link" href="Typhoid_and_paratyphoid_fever#Z1ee997715fd7396129b4d9a3ed02fe95" data-lxid="Qf0uN2">Typhoid</a> <span class="api explanation" data-category="bonus" data-content="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" id="E262bcfbb7cdeb48f442a61301bf4da7e" data-tip=" ">
</li> <li><a id="L93e9855eb880f5a2f67ba51f81d8e6d8" data-category="link" href="Tuberculosis#Z493232b0ca4528fa293eb77d42ab7772" data-lxid="5h0ief">Gastrointestinal tuberculosis</a></li> <li><a data-tip="_F05k3" id="L8a741abd2074f6bb958140944974f038" data-category="link" href="Megacolon#Zd2be65e4843043987086417ca7661fd9" data-lxid="fo0kYS">Toxic megacolon</a></li> </ul>
</li> <li class="condensed-hidden-step1">
<a href="Intestinal_ischemia#Z25168aee9d4e0266b8ee7dae3d33cc08" data-category="link" id="Laae21b47f08435340256ef21b136851c" data-lxid="cS0aA2">Bowel ischemia</a> <ul class="condensed-hidden-step1">
<li>
<a data-tip="2O0T7T" href="Bowel_obstruction#Zd632dab0bd82fad268f38b319729e1c3" data-category="link" id="Lac92115666969d0482f1e32838a3f3e3" data-lxid="230T3f">Bowel obstruction</a> (i.e., adhesions, <a data-tip="ftWk1M0" id="L9dc3f40a753adeae9a493a89e8d75b70" data-category="link" href="Sigmoid_volvulus_and_cecal_volvulus#Z72cadad819de2f5db0a50bf0b525dafa" data-lxid="9H0Nsh">volvulus</a>, <a data-tip="OHXIqz" id="L4d553083dec4ede94659af1ba749ed5d" data-category="link" href="General_oncology#Z8c3bce39ca977e0f872b6d9fb3be8cfb" data-lxid="WM0Png">malignancy</a>) <span class="api explanation" data-category="bonus" data-content="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" id="Ec0733f883fc193cf86fbe505ba39db6a" data-tip=" "> 
</li> <li><a data-tip="GF0Bj3" id="L703c4f8d79d7007ee95f3aa64d7582a7" data-category="link" href="Intestinal_ischemia#Z22a7e24fc886bd826804145f33943d15" data-lxid="cS0aA2">Acute mesenteric ischemia</a></li> </ul>
</li> <li class="condensed-hidden-step1">
Trauma <ul class="condensed-hidden-step1">
<li>
<a data-tip="tdbX7s" href="Penetrating_trauma#Z27ee2fb8e73649a5d0f45668d31914ce" data-category="link" id="L765565f8754ec73e1762d90d1e23562c" data-lxid="_P05hT">Penetrating trauma</a> (e.g., <a data-tip="1kW25l0" id="L823bb01beb88bf673490166706992cad" data-category="link" href="Wound_treatment#Z4dbb96285fec539927f9dcf5771ab85b" data-lxid="ph0LUf">stab injury</a>, <a data-tip="Qh0udf" id="L88fdeac766e691db4f5618d61aff1fb9" data-category="link" href="Hospital-acquired_infections#Zc74719fbc35d81e58337f58d0d2a90b6" data-lxid="_f05K2">iatrogenic</a> perforations): e.g., post-<a data-tip="ty0XSi" id="L61970e781c396f9f702886033a21cf68" data-category="link" href="Choledocholithiasis#Z5b9118463e989a0db84a025ca7a2606b" data-lxid="5I0iWh">ERCP</a> <a data-tip="v4cAOc0" id="L195f1d2e15b1bf5106286cc69448fa8f" data-category="link" href="Small_intestine#Z9920987de758b4f042fe199e624f79df" data-lxid="eJ0xGS">duodenal</a> perforation 
</li> <li>
<a data-tip="tdbX7s" href="Penetrating_trauma#Z27ee2fb8e73649a5d0f45668d31914ce" data-category="link" id="L01a7543933e1e82287e4d4e5a404284d" data-lxid="_P05hT">Penetrating trauma</a> (e.g., <a data-tip="1kW25l0" id="L50fcccd56b1f5622556ecf2fe2c5040b" data-category="link" href="Wound_treatment#Z4dbb96285fec539927f9dcf5771ab85b" data-lxid="ph0LUf">stab injury</a>) 
</li> <li><a data-tip="Qh0udf" id="Lae083d079a20e0c80f4e5b17c7c6c2ac" data-category="link" href="Hospital-acquired_infections#Zc74719fbc35d81e58337f58d0d2a90b6" data-lxid="_f05K2">Iatrogenic</a> perforations (e.g, during <a data-tip="nWb7Ns" href="Colonoscopy#Za4aebc8baa131b83620292e8d0363739" data-category="link" id="L64082e7309842f12709dd1608a38aaea" data-lxid="T806N3">colonoscopy</a>, <a data-tip="eo0xaS" href="Laparoscopic_surgery#Zf1770976ce9dfbbd067c82067a41ad21" data-category="link" id="Lfa7d22094548706c16bbab6b34f326f2" data-lxid="B50zmg">laparoscopic surgery</a>): e.g., post-<a data-tip="ty0XSi" id="L6c608c3076236d7782309dcfd6277d46" data-category="link" href="Choledocholithiasis#Z5b9118463e989a0db84a025ca7a2606b" data-lxid="5I0iWh">ERCP</a> <a data-tip="v4cAOc0" id="Lf1f06db337a9e87b2d1cfe8cd2fe9f5c" data-category="link" href="Small_intestine#Z9920987de758b4f042fe199e624f79df" data-lxid="eJ0xGS">duodenal</a> perforation</li> <li>
<a id="L8d798081498a0cf6c6e22c7ae606ca3b" data-category="link" href="Blunt_trauma#Z59ef0ec37acf97d349b2195aaba30bb2" data-lxid="GL0B_g">Blunt abdominal trauma</a> <span class="api explanation" data-category="bonus" data-content="QXMgdGhlIGJvd2VsIGlzIGEgY29tcHJlc3NpYmxlIG9yZ2FuLCA8YSBocmVmPSJCbHVudF90cmF1bWEjWjU5ZWYwZWMzN2FjZjk3ZDM0OWIyMTk1YWFiYTMwYmIyIiBkYXRhLWNhdGVnb3J5PSJsaW5rIiBpZD0iTDc3OTI2Y2Y2NDBiMjA1YWY2YjNiNTgxMmZiZTQ4M2RiIiBkYXRhLXNlY3Rpb24taWQ9InFrY0NLYzAiIGRhdGEtbHhpZD0iR0wwQl9nIj5ibHVudCBhYmRvbWluYWwgdHJhdW1hPC9hPiBpcyBhbiB1bmNvbW1vbiBjYXVzZSBvZiBnYXN0cm9pbnRlc3RpbmFsIHBlcmZvcmF0aW9uLgo=" id="Efa5edfb006825a48b3cd51963dbccaba" data-tip=" ">
</li> </ul>
</li> <li class="condensed-hidden">
Miscellaneous <ul>
<li><a href="Foreign_body_ingestion#Z24a0f7b55d7c9d01665f5daa6a0dbd53" data-category="link" id="L841b35a6d367e546aa72a5f949276a7f" data-lxid="SH0yph">Foreign body ingestion</a></li> <li>
Drug-induced (e.g., <a data-tip="riafG4" id="Lc4b76a6f05758d6e10128f2639ed90b6" data-category="link" href="Non-opioid_analgesics#Z6d53b6cfe3376a70645a5c797293e56a" data-lxid="BN0zWg">NSAIDs</a>, <a data-tip="4L03Bg" href="Glucocorticoids#Z521ecba6f9748e7fed6b743a73ccfabd" data-category="link" id="L14f4ca1f93d5e19355c55d2248874d04" data-lxid="km0mfg">glucocorticoids</a>, <a data-tip="V5bGQ8" id="L7d27ab3e0619c73d22b789bbb43bed11" data-category="link" href="Stimulant_intoxication_and_withdrawal#Ze484aa13dc518fe96d58522a9f0446ba" data-lxid="nF07i3">cocaine</a>)</li> <li>
<a data-tip="-L0DZS" href="Radiation_therapy#Zd120147b0e92bb22668d9e60dfbdc88b" data-category="link" id="Lc9bd6cec8d5dd1742673168362b7789d" data-lxid="L50wkg">Radiation therapy</a> to the abdominopelvic or lower thoracic region</li> <li>Post <a data-tip="Dhb1Tt" id="L5c1076524dfc4abcf76a625661164e7d" data-category="link" href="Transplantation#Z51f67fde61bd25fe68f2ed7133b180ef" data-lxid="gn0Fsg">renal transplant</a> <span class="api explanation" data-category="bonus" data-content="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" id="E04f0b33e135b278d1bbd2e5c3c390d6c" data-tip=" "> [4]</li> </ul>
</li> </ul>

Etiology

Visceral fibers from internal organs may project pain onto a specific dermatome or myotome, which can be misinterpreted as somatic pain. Commonly, the pain is not projected onto the whole dermatome, but is more intense at specific points in the corresponding dermatome (blue areas).

Referred pain of important internal organs

Clinical features

X-ray abdomen (AP erect view) and chest (PA and lateral views)
Multiple air-fluid levels are seen in the colon and small bowel (examples indicated by black lines). Some dilated segments of left colon are seen and gas is present in the peritoneal space as a result of bowel perforation. Gas is primarily located beneath the diaphragms (green overlay) because of the erect positioning of the patient. Additional gas has dissected into the retroperitoneum (examples indicated by red overlay) and is visible as linear collections parallel to the spine.

Pneumoperitoneum and Pneumoretroperitoneum

X-ray abdomen (AP view in left lateral decubitus position)
The left lateral decubitus, or left side down decubitus, radiograph was obtained with the patient's left (L) side dependent on the x-ray table. The image is centered on the nondependent right (R) hemidiaphragm. Free intraperitoneal air (pneumoperitoneum; green overlay) is interposed between the right hemidiaphragm and liver.

Free intraperitoneal air

Ultrasound right upper quadrant
Increased echogenicity and thickening of the peritoneal stripe (white arrow) is accompanied by reverberation artifacts (green overlay).
Free air has collected anteriorly in the prehepatic space in this supine patient and abuts the parietal peritoneum creating a very reflective interface. The enhanced peritoneal stripe sign (EPSS) is helpful in the detection of pneumoperitoneum.

Enhanced peritoneal stripe sign

Click on the overlay icon below the taskbar on the left to toggle the overlay on and off. 
CT abdomen (with IV and oral contrast; portal venous phase; axial plane) of a patient with abdominal pain after a colonoscopy
A large amount of free intraperitoneal gas (examples indicated by green dashed outlines) is present in the anterior abdomen. It is the result of perforation of the anterior wall of the colon (red overlay) in the region of the rectosigmoid transition. There are several small gas bubbles (examples indicated by green dashed outlines) within the mural defect and within nearby pelvic fatty tissue. A small amount of free fluid (blue overlay) is present in the right hemipelvis along with inflammatory fatty and fascial stranding.
Surgical clips (yellow arrowheads) in the gallbladder fossa are the result of a previous cholecystectomy. There is slight post-surgical pneumobilia (green arrowheads). A calcified uterine leiomyoma (green overlay) is seen in the pelvis.

Colonic perforation

X-ray chest (PA view)
Free intraperitoneal gas (green overlay) is visible under both the right and left hemidiaphragms.

Pneumoperitoneum

X-ray chest (upright position; left lateral view) of a female patient presenting with acute abdominal pain
Air is seen as a radiolucent column (green overlay) underneath the diaphragm (white dashed line), which appears as a thin semicircular radiopacity immediately inferior to the pulmonary shadow.
Air underneath the diaphragm is typically seen on x-rays of patients with pneumoperitoneum and indicates the perforation of a hollow viscus.

X-ray abdomen (supine; AP view)
Lucencies indicating free air in the retroperitoneal space dissect along numerous tissue planes (examples indicated by green overlay) and outline the right kidney (margin indicated by blue lines) and the psoas muscle (margin indicated by red line). In addition, the liver edge (yellow outline) is outlined by free air in the peritoneal space, which is also seen along several loops of bowel (examples indicated by arrows).

Pneumoretroperitoneum and pneumoperitoneum

CT abdomen (with oral and IV contrast; axial plane) of a patient with abdominal distention
A large amount of free air is seen in the peritoneal cavity (indicated by arrows) anterior to the liver (L) and stomach (St). A perforation site was not identified by CT.
Pneumobilia (example indicated by green overlay) is due to a biliary stent (not shown). Cysts in the right kidney are partially visible on this image (red overlay).
Sp: spleen

Abdomen CT (IV and oral contrast; coronal section)
The appendix (green overlay) is markedly distended, as evidenced by its distinctly visible hypodense lumen. A localized hypodense fluid collection (hatched area) with a well-defined hyperdense rim is visible at the cecal end of the appendix, indicating a periappendiceal abscess that is partially compressing the bladder.

Appendiceal abscess

Diagnosis

See “Differential diagnoses” in “<a data-tip="1Qb2Et" href="Acute_abdomen#Z24dc105fa608cb7dad9e5eada9a97d2b" data-category="link" id="L59b6168e44d85619db536e285ba6952a" data-lxid="N50-4g">Acute abdomen</a>”.
The differential diagnoses listed here are not exhaustive.

Differential diagnoses

Treatment

See “<a data-tip="bcYHaL" href="ABCDE_approach#Z1ac9cff2c246c57c842ae7e18ff24749" data-category="link" id="L9392f3f6dfe3ad322a1a0717d783644e" data-lxid="YI0nYh">Primary survey</a>” for the general approach to <a href="Management_of_trauma_patients#Ze99c35011e3521f2455031319e96fe10" data-category="link" id="La9171d7ae6fc0521df05cdd37b3059db" data-lxid="4N03Yg">trauma patients</a>; see also “<a id="L6bc480143af191f4a308fcdc357d9e3c" data-category="link" href="Blunt_trauma#Z59ef0ec37acf97d349b2195aaba30bb2" data-lxid="GL0B_g">Blunt abdominal trauma</a>” (BAT) and “<a id="L14faec8decb79b7d18df1c1ce6b2ca9c" data-category="link" href="Penetrating_trauma#Z12f19dc41aa8979ce0091797a82eb7a6" data-lxid="_P05hT">Penetrating abdominal trauma</a>.” <h2 id="Y5867b4644bf21d11504317c83138b7d3">Diagnosis [17][18]
</h2> <ul>
<li>
Emergency <a id="L8571f2b4f0e2efa1086773a1e58d4a48" data-category="link" href="Surgery_clerkship#Za68e01313423572283ce418087f356cb" data-lxid="7I04Vh">surgery</a> consult (prior to imaging) in patients with <span class="api explanation" data-category="bonus" data-content="SW5qdXJpZXMgaW4gdGhlc2UgcGF0aWVudHMgYXJlIHR5cGljYWxseSBldmFsdWF0ZWQgaW50cmFvcGVyYXRpdmVseSwgZS5nLiwgZHVyaW5nIDxhIGRhdGEtdGlwPSJiSGNIS2QwIiBocmVmPSJQZW5ldHJhdGluZ190cmF1bWEjWmM5NmI2OWE0YmM5ODExOTU1N2U1NDA4Nzk3NmYzNGQ3IiBkYXRhLWNhdGVnb3J5PSJsaW5rIiBpZD0iTDBkMTRiZGIxYjM5YmZiNzgxNTRmMWQ5YzY5MTk1YTY1IiBkYXRhLXNlY3Rpb24taWQ9InI4WGZMLSIgZGF0YS1seGlkPSJfUDA1aFQiPmV4cGxvcmF0b3J5IGxhcGFyb3RvbXk8L2E+Lgo=" id="E3c246d29c88efd48f04115acd92ed081" data-tip=" ">: <ul>
<li>Suspected GI perforation due to <a id="L9bbfb77e8775d7f53a360fbc02b2b0dd" data-category="link" href="Penetrating_trauma#Z12f19dc41aa8979ce0091797a82eb7a6" data-lxid="_P05hT">penetrating abdominal trauma</a>
</li> <li>Suspected traumatic GI perforation with <a data-phrasegroup-id="3LdSxq0" data-category="bonus" class="api dictionary" data-content="PHA+QSBzdGF0ZSBvZiByYXBpZGx5IGRldGVyaW9yYXRpbmcgYW5kL29yIGZsdWN0dWF0aW5nIGhlbW9keW5hbWljIHBhcmFtZXRlcnMgKGUuZy4sIGhlYXJ0IHJhdGUsIGJsb29kIHByZXNzdXJlKS4gQ2FuIGJlIGEgbWFuaWZlc3RhdGlvbiBvZiBjaXJjdWxhdG9yeSBzaG9jaywgY2FyZGlhYyBhcnJoeXRobWlhLCBoZWFydCBmYWlsdXJlLCBhbmQvb3IgaHlwZXJ0ZW5zaXZlIGNyaXNlcy48L3A+" id="Lb51e3f72c211734cb55a7380a9d65c48" data-source="Lb51e3f72c211734cb55a7380a9d65c48" data-tip="3LdSxq0">hemodynamic instability</a>
</li> </ul>
</li> <li>
Maintain high index of suspicion: Clinical features may be subtle. <ul>
<li>Patients with BAT are at elevated risk, especially if they also have <span class="api explanation" data-category="bonus" data-content="SW50ZXN0aW5hbCBpbmp1cmllcyBvY2N1ciBpbiA8c3BhbiBjbGFzcz0ibm93cmFwIj4z4oCTNSU8L3NwYW4+IG9mIHBhdGllbnRzIHdpdGggQkFUIGFuZCBhcmUgdGhlIHRoaXJkIG1vc3QgY29tbW9uIHR5cGUgb2YgaW5qdXJ5IGlkZW50aWZpZWQgb24gaW1hZ2luZyBpbiB0aGVzZSBwYXRpZW50cy4K" id="Ec5d2713cac57504977df246c5b296c30" data-tip=" ">: [18] <ul>
<li>High-energy injury: e.g., resulting from high-speed <a id="L3600b1633789f0aa30b43da4d073732d" data-category="link" href="Blunt_trauma#Zf50d1cd6c34dd99b68401df46d19140f" data-lxid="GL0B_g">motor vehicle collision</a>
</li> <li>
Seat belt sign (typical injury after a vehicle collision with <a data-tip="_Ca5u5" id="L759827416f871528a5ab151915dbbe22" data-category="link" href="Principles_of_dermatology#Z90b87f94f0c1fcad467038989cfa3eda" data-lxid="_405NT">ecchymoses</a> on the neck or on the flank caused by the seat belt strap) with <a id="Lb67058944f3b19843a6d47a1661533a9" data-category="link" href="Principles_of_pain_management#Zd673a3f7ee36023aab5a267899e984cc" data-lxid="xN0EWg">pain</a> and guarding</li> <li>Other injuries associated with hollow <a data-phrasegroup-id="wdbhHs" data-category="bonus" class="api dictionary" data-content="PHA+QW4gaW50ZXJuYWwgb3JnYW4sIHNwZWNpZmljYWxseSBhbiBvcmdhbiBsb2NhdGVkIHdpdGhpbiB0aGUgYWJkb21lbiBvciBjaGVzdC48L3A+" id="L77c7bcf7bfcf954c058384de07486ec8" data-source="L77c7bcf7bfcf954c058384de07486ec8" data-tip="wdbhHs">viscus</a> injury: e.g., abdominal aortic injury, <a data-tip="Fobgdu" id="La39f1bd67b174561c13bb6b064da3024" data-category="link" href="Vertebral_column#Zee3ee04f3405fd08ff4605042502f718" data-lxid="E6085S">L-spine</a> transverse <a href="General_principles_of_fractures#Z614665fe523af7333fad58e1e2ab8f0f" data-category="link" id="L15eb603e5b28264de45f96291178573d" data-lxid="T3063f">fracture</a>
</li> </ul>
</li> <li>
<a data-tip="Qh0udf" id="L0f3147d106df9f3831243c0a8cd39a6e" data-category="link" href="Hospital-acquired_infections#Zc74719fbc35d81e58337f58d0d2a90b6" data-lxid="_f05K2">Iatrogenic</a> injury: Suspect in patients with clinical features of GI perforation following recent <a data-phrasegroup-id="xWbEns" data-category="bonus" class="api dictionary" data-content="PHA+VGhlIHJlbW92YWwgb2YgYSBzbWFsbCBsaXZlciBzYW1wbGUgZm9yIHN0dWR5IHVuZGVyIGEgbWljcm9zY29wZSwgdXN1YWxseSBwZXJmb3JtZWQgdGhyb3VnaCB0aGUgaW5zZXJ0aW9uIG9mIGEgbmVlZGxlIHRocm91Z2ggdGhlIHNraW4gYW5kIGFiZG9taW5hbCB3YWxsLjwvcD4=" id="L26a59b2b79000d8d639fc4a442192162" data-source="L26a59b2b79000d8d639fc4a442192162" data-tip="xWbEns">liver biopsy</a>, <a data-tip="qRbCLt" href="Paracentesis#Z298f094c80caa2931a43acdefb33db7b" data-category="link" id="L0e156d0e5ab9a27b3a772a9f33d506d0" data-lxid="PF0WR3">paracentesis</a>, <a data-tip="yNaddO" id="L15fffbba20c760239dcc6b548300dfba" data-category="link" href="Renal_replacement_therapy#Z1adeaba22f61aeec2bb03feeebf1e47b" data-lxid="S50yjg">peritoneal dialysis</a> or lavage, or GI endoscopy.</li> </ul>
</li> <li>
CT abdomen: test of choice for all stable patients <span class="api explanation" data-category="bonus" data-content="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" id="Ef1fd3df909e375af5a77796081e786a7" data-tip=" "> <ul>
<li>In patients with BAT, evidence of hollow <a data-phrasegroup-id="wdbhHs" data-category="bonus" class="api dictionary" data-content="PHA+QW4gaW50ZXJuYWwgb3JnYW4sIHNwZWNpZmljYWxseSBhbiBvcmdhbiBsb2NhdGVkIHdpdGhpbiB0aGUgYWJkb21lbiBvciBjaGVzdC48L3A+" id="L4dd974916fd0ede33b88c8615990797b" data-source="L4dd974916fd0ede33b88c8615990797b" data-tip="wdbhHs">viscus</a> injury may be absent on the initial CT abdomen.</li> <li>Consider repeat imaging in at-risk patients with BAT, especially if they have: <ul>
<li>Persistent <a id="L9f77d8694d837b58e9459d6f933769e6" data-category="link" href="Principles_of_pain_management#Zd673a3f7ee36023aab5a267899e984cc" data-lxid="xN0EWg">pain</a>
</li> <li><a data-phrasegroup-id="ewcx3e0" data-category="bonus" class="api dictionary" data-content="PHA+QSB0eXBlIG9mIHNldmVyZSBwYWluIGV4cGVyaWVuY2VkIGJ5IGFuIGluZGl2aWR1YWwgdGhhdCBpcyBpbmNvbnNpc3RlbnQgd2l0aCB0aGUgcGh5c2ljYWwgZXhhbWluYXRpb24gKGUuZy4sIGxpdHRsZSBvciBubyBmaW5kaW5ncyB0aGF0IGNvdWxkIGV4cGxhaW4gdGhlIHNldmVyaXR5KS4gQ2FuIGJlIGNhdXNlZCBieSBjb25kaXRpb25zIHRoYXQgY29tcHJvbWlzZSBibG9vZCBmbG93IChlLmcuLCBjb21wYXJ0bWVudCBzeW5kcm9tZSwgbWVzZW50ZXJpYyBpc2NoZW1pYSkgb3IgbmVjcm90aXppbmcgaW5mZWN0aW9ucy48L3A+" id="Le5a1a1f0b0c39291ec37d32aa6e46c74" data-source="Le5a1a1f0b0c39291ec37d32aa6e46c74" data-tip="ewcx3e0">Pain out of proportion</a></li> <li>Delayed <a data-phrasegroup-id="6ucjHV0" data-category="bonus" class="api dictionary" data-content="PHA+QSBjb25zdGVsbGF0aW9uIG9mIGNsaW5pY2FsIGZpbmRpbmdzIHRoYXQgc3VnZ2VzdCBpcnJpdGF0aW9uIG9mIHRoZSBwZXJpdG9uZWFsIGxpbmluZyBvZiB0aGUgYWJkb21lbi4gU3ltcHRvbXMgYXJlIHVzdWFsbHkgbm9uc3BlY2lmaWMgKGUuZy4sIGFiZG9taW5hbCBwYWluLCBkaXN0ZW50aW9uLCBmZXZlciksIHdoaWxlIHBoeXNpY2FsIGV4YW1pbmF0aW9uIGZpbmRpbmdzIHR5cGljYWxseSBpbmNsdWRlIHJlYm91bmQgdGVuZGVybmVzcywgcmlnaWRpdHksIGFuZCBndWFyZGluZy48L3A+" id="L8d5485d95aba2801d79e162e45866efd" data-source="L8d5485d95aba2801d79e162e45866efd" data-tip="6ucjHV0">peritoneal signs</a>
</li> </ul>
</li> </ul>
</li> </ul>
Maintain a high index of suspicion for hollow <a data-phrasegroup-id="wdbhHs" data-category="bonus" class="api dictionary" data-content="PHA+QW4gaW50ZXJuYWwgb3JnYW4sIHNwZWNpZmljYWxseSBhbiBvcmdhbiBsb2NhdGVkIHdpdGhpbiB0aGUgYWJkb21lbiBvciBjaGVzdC48L3A+" id="Lc66ccd2d4ecf8f16d3add6025fed25cb" data-source="Lc66ccd2d4ecf8f16d3add6025fed25cb" data-tip="wdbhHs">viscus</a> injury in patients with <a id="Le98b2cc8fb67293c948865e6c0e07bb9" data-category="link" href="Blunt_trauma#Z59ef0ec37acf97d349b2195aaba30bb2" data-lxid="GL0B_g">blunt abdominal trauma</a> as clinical features may initially be very subtle. [18] <h2 id="Ydb2a3696e2796f4b6b7b8e4c6bababc7">Management</h2> <ul>
<li>
All patients: Administer <a data-phrasegroup-id="7WW4540" data-category="bonus" class="api dictionary" data-content="PHA+QW4gYW50aWJpb3RpYyB0aGF0IGlzIGFjdGl2ZSBhZ2FpbnN0IGEgd2lkZSByYW5nZSBvZiBiYWN0ZXJpYS4gT2Z0ZW4gdXNlZCBmb3IgZW1waXJpYyBhbnRpYmlvdGljIHRoZXJhcHkuIEV4YW1wbGVzIGluY2x1ZGUgdmFuY29teWNpbiwgZmx1b3JvcXVpbm9sb25lcywgYW5kIHRoaXJkLWdlbmVyYXRpb24gY2VwaGFsb3Nwb3JpbnMuPC9wPg==" id="L73577ec4d38c1d31f7e424b592be13fc" data-source="L73577ec4d38c1d31f7e424b592be13fc" data-tip="7WW4540">broad-spectrum IV antibiotics</a> and provide supportive care and monitoring identical to that for nontraumatic GI perforation.</li> <li>
Patients with <a data-tip="YNan-k" href="Sepsis#Zb3de189fac0d57eac5b7798e127a5e19" data-category="link" id="L29b19c73d7e86c83470b7c4193a17514" data-lxid="xm0E3g">sepsis</a>, <a data-phrasegroup-id="Eo08dS" data-category="bonus" class="api dictionary" data-content="PHA+SW5mbGFtbWF0aW9uIG9mIHRoZSBwZXJpdG9uZXVtICh0aGUgaW5uZXIgbGluaW5nIG9mIHRoZSBhYmRvbWluYWwgd2FsbCB0aGF0IGFsc28gY292ZXJzIG1vc3QgaW50ZXJuYWwgb3JnYW5zKSwgdXN1YWxseSBvZiBpbmZlY3Rpb3VzIG9yaWdpbi48L3A+" id="Ld583abd21517db1f5023ac4913aeebe7" data-source="Ld583abd21517db1f5023ac4913aeebe7" data-tip="Eo08dS">peritonitis</a>, or <a data-phrasegroup-id="3LdSxq0" data-category="bonus" class="api dictionary" data-content="PHA+QSBzdGF0ZSBvZiByYXBpZGx5IGRldGVyaW9yYXRpbmcgYW5kL29yIGZsdWN0dWF0aW5nIGhlbW9keW5hbWljIHBhcmFtZXRlcnMgKGUuZy4sIGhlYXJ0IHJhdGUsIGJsb29kIHByZXNzdXJlKS4gQ2FuIGJlIGEgbWFuaWZlc3RhdGlvbiBvZiBjaXJjdWxhdG9yeSBzaG9jaywgY2FyZGlhYyBhcnJoeXRobWlhLCBoZWFydCBmYWlsdXJlLCBhbmQvb3IgaHlwZXJ0ZW5zaXZlIGNyaXNlcy48L3A+" id="L6211170a13a46d54d510277a4955b0e8" data-source="L6211170a13a46d54d510277a4955b0e8" data-tip="3LdSxq0">hemodynamic instability</a>: Operative management is indicated.</li> <li>
Stable patients with <a id="L431fd0cc31ec16b7896a6d2da33d62ed" data-category="link" href="Penetrating_trauma#Z12f19dc41aa8979ce0091797a82eb7a6" data-lxid="_P05hT">penetrating abdominal trauma</a>: Operative management is typically indicated. <span class="api explanation" data-category="bonus" data-content="U3VzcGVjdGVkIGhvbGxvdyB2aXNjdXMgcGVyZm9yYXRpb24gdHlwaWNhbGx5IHByZWNsdWRlcyB0aGVzZSBwYXRpZW50cyBmcm9tIG5vbm9wZXJhdGl2ZSBtYW5hZ2VtZW50Lgo=" id="Edd4a0fbd926ede330d19ac48e4bb81d8" data-tip=" "> [19][20]
</li> <li>
Stable patients with any other traumatic etiologies: Consult <a id="Lb2984df7feb92241472b4ae7365f2af0" data-category="link" href="Surgery_clerkship#Za68e01313423572283ce418087f356cb" data-lxid="7I04Vh">surgery</a> to determine if operative or nonoperative management is most appropriate. <span class="api explanation" data-category="bonus" data-content="RXZpZGVuY2UgYW5kIHByYWN0aWNlIHZhcnkgcmVnYXJkaW5nIHRoZSBvcHRpbWFsIGFwcHJvYWNoIGZvciB0aGVzZSBwYXRpZW50cywgYW5kIHRyZWF0bWVudCBkZWNpc2lvbnMgc2hvdWxkIGJlIG1hZGUgaW4gY29uc3VsdGF0aW9uIHdpdGggYSBzcGVjaWFsaXN0IGJhc2VkIG9uIGluZGl2aWR1YWwgcGF0aWVudCBhbmQgaW5qdXJ5IGNoYXJhY3RlcmlzdGljcy4K" id="E2c69b81d7dd0ff9a7a38501786e9246f" data-tip=" "> [18][21][22][23]
</li> </ul>

Traumatic hollow viscus injury

<ul>
<li class="checkbox-list">Urgent general <a id="L2f1d081613d4ca2d42adcf42f57bcff9" data-category="link" href="Surgery_clerkship#Za68e01313423572283ce418087f356cb" data-lxid="7I04Vh">surgery</a> consult for <a data-tip="bHcHKd0" id="L8af08c486f5d62342a42a6171f1e7966" data-category="link" href="Penetrating_trauma#Zc96b69a4bc98119557e54087976f34d7" data-lxid="_P05hT">emergency exploratory laparotomy</a>
</li> <li class="checkbox-list"><a data-phrasegroup-id="QTbuqG" data-category="bonus" class="api dictionary" data-content="PGk+QWJicmV2aWF0aW9uOiBOUE88L2k+PGJyPjxwPkEgdGVybSB1c2VkIHRvIGluZGljYXRlIHRoYXQgbm90aGluZyAoZS5nLiwgbWVkaWNhdGlvbnMsIGZvb2QpIHNob3VsZCBiZSB0YWtlbiBieSBtb3V0aC4gT2Z0ZW4gdXNlZCBhcyBhIGRpZXRhcnkgcmVzdHJpY3Rpb24gb3JkZXIgaW4gcGF0aWVudHMgYXQgcmlzayBvZiBhZHZlcnNlIGV2ZW50cyBmcm9tIG9yYWwgaW50YWtlIChlLmcuLCByaXNrIG9mIGFzcGlyYXRpb24sIGFudGljaXBhdGVkIGdlbmVyYWwgYW5lc3RoZXNpYSwgcmVjZW50IEdJIHRyYWN0IHN1cmdlcnksIGNvbmRpdGlvbnMgcmVxdWlyaW5nIGJvd2VsIHJlc3QpLjwvcD4=" id="La188ca789d18b0b13ae1c12a3c872f5b" data-source="La188ca789d18b0b13ae1c12a3c872f5b" data-tip="QTbuqG">NPO</a></li> <li class="checkbox-list">
<a data-tip="90dNRo0" href="Peripheral_venous_access#Zcc875f7e66b8a9e2bffdb13a363c4b14" data-category="link" id="L7bfe1fce0e2008552fbb988a7e7dfede" data-lxid="6t0je3">IV access</a> with two large-bore <a data-tip="90dNRo0" href="Peripheral_venous_access#Zcc875f7e66b8a9e2bffdb13a363c4b14" data-category="link" id="Le34d0fd484f443fe683082f0cbee73fa" data-lxid="6t0je3">peripheral IVs</a> <span class="api explanation" data-category="bonus" data-content="UGF0aWVudHMgd2l0aCBib3dlbCBwZXJmb3JhdGlvbiBtYXkgcmFwaWRseSBkZXZlbG9wIDxhIGRhdGEtdGlwPSJZTmFuLWsiIGhyZWY9IlNlcHNpcyNaYjNkZTE4OWZhYzBkNTdlYWM1Yjc3OThlMTI3YTVlMTkiIGRhdGEtY2F0ZWdvcnk9ImxpbmsiIGlkPSJMMTUwYmJiZTk0NzgwNTAwM2MxZDg1MDUyMTcwNjRhNTUiIGRhdGEtbHhpZD0ieG0wRTNnIj5zZXBzaXM8L2E+IGFuZCA8YSBkYXRhLXRpcD0iTGdhd0RQIiBocmVmPSJTaG9jayNaOTRjZjI3ZjFjNzE5OGJiYzRiMzQ4N2YxZmRmZjgwZTYiIGRhdGEtY2F0ZWdvcnk9ImxpbmsiIGlkPSJMZDUxZTNhZjlmNTAyZDdkNWMzODliZDM2ZjkyYzJkMTYiIGRhdGEtc2VjdGlvbi1pZD0iU1NjeV9iMCIgZGF0YS1seGlkPSJrTzBtc1QiPnNlcHRpYyBzaG9jazwvYT4uCg==" id="E179f39c29910370ad27c7bc38d7a4346" data-tip=" ">
</li> <li class="checkbox-list">
Aggressive IV fluid resuscitation <span class="api explanation" data-category="bonus" data-content="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" id="E07f6af10b6d251581192c8aad63c4e27" data-tip=" ">
</li> <li class="checkbox-list">
<a data-tip="D-11zj0" href="Nasogastric_tube_placement#Zbea81401ee2fc0a96932cb6db23dc6f5" data-category="link" id="Lb6facd6bf6376a00c908eba37f8dea8f" data-lxid="X809O3">Nasogastric tube insertion</a> (continuous or intermittent suction) <span class="api explanation" data-category="bonus" data-content="VG8gZGVjb21wcmVzcyB0aGUgdXBwZXIgPGEgaHJlZj0iR2FzdHJvaW50ZXN0aW5hbF90cmFjdCNaZjA4MzMwNThiNzE1MmFmOGI1NjUzYjc5Zjc2ZmIxNTMiIGRhdGEtY2F0ZWdvcnk9ImxpbmsiIGlkPSJMNWYxODQwNjBmODI1MTQ3ZjM4NzRjYzIwMTc5Njk1NjUiIGRhdGEtbHhpZD0iTTYwTWxTIj5HSSB0cmFjdDwvYT4K" id="E0c98a60482116fb546f5437f32f4d5ba" data-tip=" ">
</li> <li class="checkbox-list">IV broad-spectrum <a href="Overview_of_antibiotic_therapy#Z4660f53b2b0c85aa3f9ab01bdf3f14f3" data-category="link" id="L2490752d17995ff9e18f63b8b754c55d" data-lxid="mm0VTg">antibiotics</a>: See “Severe infection” in “<a id="Lbc0948d18c2750d0791a549f2aecfc5c" data-category="link" href="Acute_abdomen#Z252cb40328ff487bdbc7b0bcd8eaec50" data-lxid="N50-4g">Empiric antibiotic therapy for intraabdominal infection</a>”.</li> <li class="checkbox-list"><a href="Electrolyte_repletion#Z02b9270c710b96930e101f65f39a9dad" data-category="link" id="L2dbfabd7c44f7bf0f7852ec9c1913eca" data-lxid="QJ0uFS">Electrolyte repletion</a></li> <li class="checkbox-list">
<a href="Oxygen_therapy#Za7b436c677a21fa93b35f4501c1fa24f" data-category="link" id="L2250b88da9ea8982f4a22fa1420a142a" data-lxid="EJ08DS">Supplemental oxygen</a>, if necessary</li> <li class="checkbox-list"><a id="Le0c3c42c4e5ad960820034e3523d5493" data-category="link" href="Principles_of_pain_management#Z498726f0ce401dec046932a7bc75c790" data-lxid="xN0EWg">Parenteral analgesics</a></li> <li class="checkbox-list">Parenteral <a data-tip="5L0iyg" href="Antiemetics#Z0433d6028d33825c7d6bbc62b5ff81cd" data-category="link" id="L3747e41387e0c0f56d35491adff90bee" data-lxid="qm0Cgg">antiemetics</a>
</li> <li class="checkbox-list">Admit to surgical <a data-phrasegroup-id="Duc1tV0" data-category="bonus" class="api dictionary" data-content="PGk+QWJicmV2aWF0aW9uOiBJQ1U8L2k+PGJyPjxwPkEgdW5pdCB0aGF0IHByb3ZpZGVzIHRoZSBoaWdoZXN0IGxldmVsIG9mIGNhcmUgYXZhaWxhYmxlIGluIGEgaG9zcGl0YWwuPC9wPg==" id="L3af30f4579b1a4eefbb40ab455b7e42f" data-source="L3af30f4579b1a4eefbb40ab455b7e42f" data-tip="Duc1tV0">ICU</a>.</li> <li class="checkbox-list"><a data-phrasegroup-id="7EW4CM0" data-category="bonus" class="api dictionary" data-content="PHA+VGhlIHJlZXhhbWluYXRpb24gb2YgYSBwYXRpZW50J3MgYWJkb21lbiBhdCByZWd1bGFyIGludGVydmFscyAoZS5nLiwgZXZlcnkgNCBob3VycykgYWZ0ZXIgYW4gaW5pdGlhbCAoYmFzZWxpbmUpIGFiZG9taW5hbCBleGFtaW5hdGlvbi4gQ29tbW9ubHkgcGVyZm9ybWVkIGluIHBhdGllbnRzIHdpdGggYWN1dGUgYWJkb21pbmFsIHBhaW4gb3IgdHJhdW1hIHRvIGRldGVybWluZSBpZiB0aGUgcGF0aWVudCdzIGNvbmRpdGlvbiBpcyBzdGFibGUgb3IgZGV0ZXJpb3JhdGluZy48L3A+" id="L830b682032162a6b35362cd9d0eb3984" data-source="L830b682032162a6b35362cd9d0eb3984" data-tip="7EW4CM0">Serial abdominal examination</a></li> </ul>

Acute management checklist

<ul class="condensed-hidden">
<li><a data-phrasegroup-id="Eo08dS" data-category="bonus" class="api dictionary" data-content="PHA+SW5mbGFtbWF0aW9uIG9mIHRoZSBwZXJpdG9uZXVtICh0aGUgaW5uZXIgbGluaW5nIG9mIHRoZSBhYmRvbWluYWwgd2FsbCB0aGF0IGFsc28gY292ZXJzIG1vc3QgaW50ZXJuYWwgb3JnYW5zKSwgdXN1YWxseSBvZiBpbmZlY3Rpb3VzIG9yaWdpbi48L3A+" id="Lb790bd09b9626cc2f78a210eefbd1bf6" data-source="Lb790bd09b9626cc2f78a210eefbd1bf6" data-tip="Eo08dS">Peritonitis</a></li> <li><a data-tip="ER08Kf" href="Bacteremia#Z4bd3a5213bcec7021a2d08026fec3ee5" data-category="link" id="L2396a7e2e6c9122f48c98b38500d16bc" data-lxid="EH08Hh">Bacteremia</a></li> <li><a data-tip="YNan-k" href="Sepsis#Zb3de189fac0d57eac5b7798e127a5e19" data-category="link" id="L0fde3327706a0170a7b0bf645b31d747" data-lxid="xm0E3g">Sepsis</a></li> <li><a data-tip="oga0wP" id="Le2797250fdca85447278f2ffe689bb41" data-category="link" href="Sepsis#Z797550b9a6e59de117714905f40c1374" data-lxid="xm0E3g">Multiorgan dysfunction</a></li> <li><a href="Intraabdominal_abscesses#Z3617ed450aad55d64b9c08613bef1998" data-category="link" id="L4167aee1d5b9ab869264a2c18ab80bfc" data-lxid="8u0OG3">Intraabdominal abscess</a></li> <li>Intraabdominal adhesions</li> <li><a data-tip="m3bVQt" id="L87a867dd87a325853b666ef7c2c81c6d" data-category="link" href="Intraabdominal_abscesses#Zffc65e983f9490e53bd8419504a79cf8" data-lxid="8u0OG3">Subhepatic abscess</a></li> <li><a data-tip="3ebSAs" href="Pyogenic_liver_abscess#Z788a2a21048346d74a8bba1dfdff33c5" data-category="link" id="L3075cbb38f3fb6137b9c51e000e170a5" data-lxid="8L0Ozg">Pyogenic liver abscess</a></li> <li>
<a data-tip="ZyXZd00" id="Ld332c46d7d29cf03369ceb2739fa24b3" data-category="link" href="Pelvis_and_hip_joint#Z302395fa53b6096eda0d6a50e247fdd4" data-lxid="A60RnS">Pelvic</a> <a data-tip="yVbdCs" id="Lba66899cdc83f3dbd64797eec4531986" data-category="link" href="Local_inflammatory_responses#Zc5e4bc5f6a9a7188f4806603b26e8234" data-lxid="aq0QCS">abscess</a>
</li> <li>
<a id="L29d70bc53221cf8ef1708d0864852be0" data-category="link" href="Postoperative_management#Z72cc37b607372d10bd0687f480be2d5b" data-lxid="550ikg">Postoperative complications</a> <span class="api explanation" data-category="bonus" data-content="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" id="E9017bffa740d12a6206ab24a3a74bf12" data-tip=" ">
</li> </ul>
We list the most important complications. The selection is not exhaustive.

Complications

Bowel Perforation

Management of Complicated Peptic Ulcer Disease

Gastrointestinal Complications of Transplant Immunosuppression

Practice Guidelines for Primary Care of Acute Abdomen 2015

American College of Radiology ACR Appropriateness Criteria® Acute Nonlocalized Abdominal Pain

Sonography of Small Bowel Perforation

Comprehensive Radiographic Pathology - E-Book

Point-of-Care Ultrasound Diagnosis of Pneumoperitoneum in the Emergency Department.

Sonographic detection of pneumoperitoneum.

Perforated peptic ulcer - an update

Risk of anastomotic leakage with use of NSAIDs after gastrointestinal surgery

The challenge of intra-abdominal sepsis

Current concept of abdominal sepsis: WSES position paper

Perforated peptic ulcer

Colorectal emergencies: perforated diverticulitis (operative and nonoperative management).

Rosen's Emergency Medicine

Hollow viscus injury due to blunt trauma: A review

Practice Management Guidelines for Selective Nonoperative Management of Penetrating Abdominal Trauma

Non-operative Management of Penetrating Abdominal Injuries: An Update on Patient Selection

Diagnosis and management of iatrogenic endoscopic perforations: European Society of Gastrointestinal Endoscopy (ESGE) Position Statement

Colonoscopic perforation: Incidence, risk factors, management and outcome

Management of iatrogenic perforation

Contributor Disclosures - Gastrointestinal perforation. All of the relevant financial relationships listed for the following individuals have been mitigated:
Jan Schlebes (medical editor, is a shareholder in Fresenius SE & Co KGaA).
None of the other individuals in control of the content for this article reported relevant financial relationships with ineligible companies. 
For details, please review our full conflict of interest (COI) policy: