Rupture and perforation of organs

Rupture and perforation of organs

The urinary bladder, gallbladder and gastrointestinal tract are hollow organs that contain fluid. The gastrointestinal system also contains faeces, air and a high concentration of organisms. Trauma, ischaemia or tissue ulceration may cause perforation, with resulting leak of luminal contents with peritonitis and resulting in severe abdominal pain. This may be localised to the area immediately adjacent to the perforation (for example, in a localised perforation of an appendix) or more generalised. - The initial site of onset of the pain may give a clue as to the organ involved and so help with the di ff erential diagnosis. For example, the diagnosis of a perforated peptic ulcer is supported by a past history of ulcer-type pain followed by a sudden onset of upper abdominal pain. The urgency of the situation must not be missed as such a patient can deteriorate rapidly with septicaemia. The abdomen is divided into nine areas for ease of descrip - tion ( Figure 63.2 ). These regions are demarcated by the mid - clavicular lines in the vertical axis and by the transpyloric and transtubercular lines in the horizontal axis. Figure 63.2 also indicates some of the organs and pathological processes that commonly cause pain experienced in these regions.

2 Peptic ulcer 1 3 Pancreatitis Splenic Hepatitis injury Cholecystitis 4 6 5 Renal and Renal and Bowel ureteric ureteric obstruction pain pain Aortic aneurysm ( back) 7 9 8 Diverticulitis Appendicitis Pelvic pain (Ovarian cysts, pelvic in /f_l ammatory disease, etc.) Figure 63.2 Nine sites of abdominal pain: 1, right subcostal; 2, epi

gastrium; 3, left subcostal; 4, right /f_l ank; 5, periumbilical; 6, left /f_l ank; 7, right iliac fossa; 8, suprapubic/hypogastrium; 9, left iliac fossa. (From Bailey and Love, 25th edn, courtesy of Mr Simon Paterson-Brown, Consultant Surgeon, Royal In /f_i rmary of Edinburgh.)