ACUTE ABDOMEN • SENIOR RESIDENT / SURGEON

Small Bowel Perforation

A perforated small bowel is a source-control problem first; the cause matters, but it must not delay definitive treatment.

PROTOTYPE REVIEW REQUIRED

The Call

56-year-old man with metastatic colorectal cancer

Acute central abdominal pain with diffuse rigidity and peritoneal signs. Imaging demonstrates free intraperitoneal air.

T 38.1 C • HR 112 • BP 110/64

Peritonitis plus free air should focus the team on resuscitation and source control, not diagnostic perfection.

Read the Image • Clinical Data

Upright Film / CT / Operative Image Use the archived free-air or small-bowel-perforation image with feculent contamination. Clinical image slot reserved for this case.

Make the Decision • Commit to a Plan

Small Bowel Perforation

56-year-old man with metastatic colorectal cancer

A patient has free air, diffuse peritonitis and CT evidence of small-bowel perforation with septic shock. Best next step?

A 3-cm ileal perforation is found amid heavy contamination; the patient remains on escalating vasopressors. Best principle?

After damage-control laparotomy the patient stabilizes overnight. What should the planned return address?

Find the hole, control the contamination, and address the cause.

The pathology and cause determine further treatment.

Surgical Pearls

Pitfalls

You identify a jejunal perforation in a patient with profound shock, diffuse contamination and questionable adjacent bowel viability. What principle should guide reconstruction?