full-thickness loss of bowel wall integrity that results in perforation peritonitis.

Aetiology

• Ulcerative
  • Peptic ulcer
  • Malignancy
  • Inflammatory bowel disease
• Infection
  • Diverticulitis
  • Acute appendicitis
  • Typhoid
  • GI tuberculosis
  • Toxic megacolon
• Bowel ischemia
  • Bowel obstruction
  • Acute mesenteric ischemia
• trauma
  • Penetrating ischemia
  • Blunt abdominal trauma
• Misc
  • Foreign body ingestion
  • Drug-induced (NSAID’s, glucocorticoids, cocaine)
  • Radiation therapy
  • Post renal transplant

Clinical Features

• Sudden onset of abdominal pain and abdominal distension
• Nausea, vomiting, obstipation
• Fever, tachycardia, tachypnoea, hypotension (perforation peritonitis and shock)
• Decreased or absent bowel sounds (paralytic ileus)
• Loss of liver dullness on RUQ percussion (due to presence of air between diaphragm and liver)

Features specific to particular etiologies:

• Localized RLQ pain – contained perforated appendicitis
• Localized LLQ pain – contained perforated diverticulitis