Signs of a bowel perforation

Updated April 17, 2017

A bowel perforation is a hole that occurs in the large or small bowel and it is considered a medical emergency. This condition can be caused by many different diseases such as appendicitis, Crohn's disease, ulcerative colitis, gallstone or gallbladder infection, trauma or an error in a medical procedure. The symptoms that this condition mainfests can be quite severe.

Abdominal Pain

When a perforation occurs with a person's large or small bowel it can cause the contents of the bowel to leak out. This causes inflammation to the surrounding tissue in the abdominal cavity which can lead to an abscess. An abscess is a pocket of infection or pus that is caused by this leak. In these cases, a person will experience pain that quickly escalates. Additionally, the abdomen can become distended due to the build-up of fluid or even gas release from dying tissues. The abdominal area will become very tender and the person will exhibit signs of extreme discomfort. If this condition is not treated it can cause severe damage and even death.


If the leakage from the bowel perforation is not identified it can cause a severe infection which can cause a high fever. If the infection gets into the bloodstream it can cause sepsis, which is an extremely serious illness and can cause death. Along with a fever, a person can suffer from extreme chills due to the fever raging in their bodies. Along with these symptoms, the person may be drenched in sweat or have "cold sweating" while battling the symptoms.


Severe nausea and vomiting are often signs of a perforated bowel. This can happen in cases where there was a bowel blockage that led to bowel perforation. It also occurs when the contents of the colon leak into the body and cause an infection. Many times a person will become extremely nauseous and begin vomiting green bile. A person who is having these symptoms should immediately go to a physician or emergency room.


Bleeding or hemorrhaging usually manifests after the bowel perforation has moved into a serious deadly stage. It usually occurs after a person has experienced many of the other symptoms listed above. The perforation and bleeding can also occur as a result from diverticulitis, colon cancer or during a medical procedure such as a colonoscopy.

Stephen M. Kavie, MD, and Mare D. Basson, MD, PhD, report that the person who experiences a perforated colon with bleeding may need surgical intervention if the colon does not repair the hole itself. The blood can back up and cause the patient to vomit blood or the patient can have rectal bleeding.

Pain in Hip or Groin

Pain in the hip or groin can also be a sign of a bowel perforations. The patient will usually increase throughout the day and can be quite severe, causing the person to have difficulty walking. The area will also be very painful to the touch and some people may think that they have appendicitis. However, in some cases it is an appendicitis that has ruptured and now the person is at risk of infection and even death. In this circumstance, immediate emergency medical attention is key.

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About the Author

Kristie Jernigan is a health writer with over 17 years of experience as a medical social worker. She has worked mainly with the elderly population and with children. She holds a Bachelor of Science in psychology and early childhood from East Tennessee State University and a Master of Science in health care administration and gerontology from the University of Phoenix.