Intestinal Ischemia and Perforation

Clinical Presentation

The most common signs and symptoms of intestinal ischemia or perforation include abdominal pain (74-95%), guarding/rebound tenderness (82.5%), tachycardia (62.5%), leukocytosis (40%), fever (38%), rectal bleeding (15%), and abdominal distension (6.6%) 1
Sudden onset of severe abdominal pain, abdominal distension, nausea and vomiting, and rectal bleeding are common symptoms of intestinal perforation 1, 4
Diffuse peritonitis with guarding and rebound tenderness, abdominal distension, tachycardia (62.5%), and fever (38%) are common physical examination findings in intestinal perforation 1, 4

Leukocytosis (40%) and elevated C-reactive protein (CRP) are common laboratory findings in intestinal ischemia or perforation 1, 5
Elevated procalcitonin (PCT) in cases of delayed presentation (>12h) is a significant laboratory finding in intestinal ischemia or perforation 1

CT scan is the most accurate diagnostic tool (>90% accuracy) for detecting perforation, and can detect small amounts of free intra-peritoneal air and fluid 5, 6
Multi-detector CT (MDCT) is 86% accurate in predicting the site of perforation 5

Delay in diagnosis beyond 24 hours increases the likelihood of requiring more invasive treatments 1
Elderly or unconscious patients may have minimal signs on clinical examination despite severe disease 3
A small number of patients with intestinal perforation (5%) may remain asymptomatic 1