[3] Symptoms of gastrointestinal perforation commonly include severe abdominal pain, nausea, and vomiting.

Perforation may be caused by trauma, bowel obstruction, diverticulitis, stomach ulcers, cancer, or infection.

[2] Perforation anywhere along the gastrointestinal tract typically requires emergency surgery in the form of an exploratory laparotomy.

[5] Posterior gastric wall perforation may lead to bleeding due to the involvement of gastroduodenal artery that lies behind the first part of the duodenum.

Bowel obstruction is a blockage of the small or large intestine which prevents the normal movement of the products of digestion.

[11] It may occur due to scar tissue after surgery, twisting of the bowel around itself, hernias, or gastrointestinal tumors.

Extension of the ulcer through the lining of the digestive tract results in spillage of the stomach or intestinal contents into the abdominal cavity, leading to an acute chemical peritonitis.

[13][14] Helicobacter pylori infection and overuse of non-steroidal anti-inflammatory drugs[15][16] may contribute to formation of peptic ulcers.

In intestinal perforation, gas may be visible under the diaphragm on chest x-ray while the patient is in an upright position.

While x-ray is a fast and inexpensive to screen for perforation, an abdominal CT scan with contrast is more sensitive and specific for establishing a diagnosis as well as determining the underlying cause.

[19] Both CT and x-ray may initially appear normal, in which case diagnosis can be made by open or laparoscopic exploration of the abdomen.