The small and large intestines (bowels) are the longest parts of the gastrointestinal tract. It carries partially digested food from the stomach through a windy path during which it is digested further and water and wastes added before stool is passed out of the rectum. The distance of this intestinal transit is about 7 meters (25 feet) which is the combined length of the small and large intestines.
How does the bowel burst?
The bowel walls are relatively thick with several layers. Each layer plays a different role in ensuring that the bowel is able to complete its functions. This includes the digestion and absorption of nutrients, movement of intestinal contents towards the rectum and anus as well as preventing the intestinal contents from making contact with the other organs and structures of the abdominal cavity.
A penetrating injury to the abdomen which pierces the bowels is the most obvious cause of a burst bowel. However, this is the not the most common cause. Most of the time a burst bowel arises when a portion of the bowel wall is weakened. This can occur with various diseases and disorders involving the intestines (bowels). If the weakening is severe or the disease extends through the bowel wall, it can eventually lead to a perforation.
Read more on perforated bowels.
What happens if the bowel bursts?
The intestines contain a host of different substances, ranging from the remnants of consumed foods and beverages to digestive enzymes and wastes. In addition there is large amounts of microorganisms, specifically bacteria, in the lower parts of the small intestine and throughout the large intestine.
The walls of the intestines separate the internal intestinal environment from the abdominal cavity. In addition the walls contain small muscle which contract and relax in a rhythmic manner to push the intestinal contents. Eventually stool is expelled through the anus.
If the bowels rupture or a tear forms in it, then some of these substances (food, fluid, digestive enzymes), bacteria and stool can empty into the abdominal cavity. It can then result in irritation of the lining around the organs (the peritoneum) or even lead to an infection. This may lead to a condition known as peritonitis.
Contained vs Free Perforation
It is important to note that a tear may not always cause the intestinal contents to spill out into the abdominal cavity. Perforations of the bowel may be contained when the surrounding abdominal organs press against the tear and keep the intestinal contents within the intestine. This is known as a contained perforation.
If the intestinal contents are able to spill out then it is known as a free perforation. This is more likely to lead to serious complications. Upper intestinal tears may be contained or free perforations. However, when a tear occurs in the lower bowel then it is usually a free perforation.
Read more on small intestine hole.
Is a burst bowel deadly?
A burst bowel (perforated intestine) is potentially life threatening. Complications like bacteremia or septicemia which may occur with peritonitis are very serious and can be deadly without prompt treatment and proper management. It can further complicate into shock and multi-organ failure. The elderly in particular are at a greater risk of these serious and life threatening complications from a burst bowel.
Causes of Burst Bowels
There are many possible causes of a tear or rupture of the small and/or large intestines. Acute appendicitis, acute diverticulitis and a perforated peptic ulcer are the leading causes of intestinal perforation. The signs and symptoms of a burst bowel typically includes severe abdominal pain along with other features depending on the location of the tear. It is imperative that immediate medical attention is sought.
Both penetrating injuries and blunt force trauma can cause a burst bowel. These injuries may arise from an assault, fall, motor vehicle accidents and contact sports. People with various bowel diseases that weaken the wall are at a greater risk of a perforation from blunt force trauma. However, a perforation can even occur in an otherwise healthy bowel, both in adults and children.
Various gastrointestinal diseases can lead to a perforated bowel in a severe cases or increase the risk of a burst bowel following blunt force trauma or medical procedures. These conditions include:
- Appendicitis: Inflammation of the vermiform appendix usually due to an obstruction and infection. It is one of the leading causes of large intestine perforation.
- Diverticulitis: Inflammation of the abnormal outpouchings in the intestines (diverticula), especially the colon.
- Peptic ulcers: Open sores (ulcers) in the duodenum of the small intestine.
- Inflammatory bowel disease: Inflammation and ulcers of the bowel caused by immune mediated reactions.
Drugs and Medical Procedures
Certain medication like NSAIDs (non-steroidal anti-inflammatory drugs) may increase the risk of perforation when there are underlying conditions like peptic ulcers and diverticular disease. It tends to be a greater risk among the elderly using these drugs.
Various procedures may also lead to accidental bowel perforation or increase the risk of rupture and tears. This includes:
- Endoscopic investigations including ERCP and colonoscopy
- Endoscopic biliary stent
- Radiation therapy
- Kidney transplantation
Certain foreign bodies, particularly those with sharp edges or points, can cause a perforated bowel. Most of the time this is a risk in infants and young children who may swallow sharp objects, such as toothpicks, pins or needles, razor blades or glass shards. It can also occur among adults who unintentionally consume these objects in food.
Various caustic substances can cause a perforation. Depending on the type of substance in question, the tear can occur within minutes to hours but sometimes may be delayed for days. These substances may be consumed accidentally, especially among children, although there are cases where it is intentionally consumed.
A burst bowel may occur in several other conditions or arise as complications in certain conditions, such as:
- Bacterial infections like typhoid fever.
- Ischemic bowel conditions like ischemic colitis.
- Cancers includng small bowel carcinoma, colorectal cancer, other intra-abdominal malignancies, lymphoma and even kidney cancer.
- Benign growths such as desmoid tumors.