What should be the focus of medical history in the evaluation of intestinal perforation?

Updated: Jul 24, 2020
  • Author: Samy A Azer, MD, PhD, MPH; Chief Editor: John Geibel, MD, MSc, DSc, AGAF  more...
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Answer

A careful medical history often suggests the source of the problem, which is subsequently confirmed by clinical examination and radiologic study findings. Possible etiologies include the following:

  • Penetrating injury or blunt trauma to the lower chest or abdomen
  • Aspirin, nonsteroidal anti-inflammatory drug (NSAID), or steroid intake, particularly in elderly patients
  • Treatment for peptic ulcer disease or ulcerative colitis; perforation due to acute ulcerative colitis (usually identified by the history of the primary disease and the results of past investigations)
  • Abdominal pain
  • Vomiting - This occurs, albeit uncommonly, in patients with a perforated ulcer; vomiting is, however, frequently noted in patients with acute cholecystitis; in patients with appendicitis, pain almost always precedes vomiting by 3-4 hours, whereas the converse is true in gastroenteritis
  • Hiccup - This is a common late symptom in patients with a perforated peptic ulcer
  • History of travel to or of residing in tropical areas, with symptoms suggestive of typhoid fever (eg, fever, abdominal pain, abdominal distention, constipation, bilious vomiting)
  • History of endoscopic procedures, such as colonoscopy [5, 6, 7, 8]
  • History of chronic disease, such as ulcerative colitis

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