A bowel perforation allows intestinal contents (e.g., stool, bacteria) to leak into the abdominal cavity, causing severe infection and inflammation. Common causes include:

• Peptic ulcer disease: Perforated gastric or duodenal ulcers.
• Diverticulitis: Ruptured diverticula in the colon.
• Trauma: Blunt or penetrating injuries (e.g., stab wounds, accidents).
• Appendicitis: Ruptured appendix leading to perforation.
• Bowel obstruction: Ischemia or pressure causing perforation (e.g., volvulus, tumors).
• Inflammatory bowel disease (IBD): Severe Crohn’s disease or ulcerative colitis.
• Infections or ischemia: Typhoid fever, mesenteric ischemia, or tuberculosis.

Bowel perforation repair is indicated to:

• Close the perforation and prevent further leakage.
• Treat peritonitis or abscesses.
• Restore bowel continuity or create a temporary/permanent stoma (e.g., colostomy) if needed.

In India, hospitals like Apollo, Fortis, Medanta, Narayana Health, and AIIMS specialize in emergency bowel surgery, often using open or laparoscopic techniques based on the patient’s condition.

Recovery is gradual, with significant emphasis on infection control and bowel function restoration:

1. Hospital Stay:
   • Open surgery requires 5–10 days, including 1–3 days in the ICU.
   • Laparoscopic repair involves 3–7 days, with 1–2 days in the ICU.
2. Post-Procedure Care:
   • Pain is managed with medications (e.g., opioids initially, then NSAIDs).
   • IV antibiotics treat peritonitis or sepsis; drains are monitored for output and removed when appropriate.
   • Nasogastric tubes are removed once bowel function resumes (typically 2–5 days).
   • Patients with stomas receive training from an enterostomal therapist for colostomy/ileostomy care.
3. Activity and Diet:
   • Light walking resumes within 1–2 days to prevent blood clots and promote bowel motility.
   • Strenuous activities, heavy lifting, or driving are avoided for 6–8 weeks (open surgery) or 4–6 weeks (laparoscopic).
   • Diet progresses from clear liquids to soft foods as bowel function returns, typically within 3–7 days.
   • High-fiber diets are introduced gradually (after 4–6 weeks) to prevent constipation, with hydration emphasized.
4. Follow-Up:
   • Follow-up visits at 1–2 weeks and 4–6 weeks assess wound healing, stoma function (if applicable), and recovery.
   • Imaging (CT or ultrasound) may be performed to check for abscesses or leaks.
   • Stoma reversal (if temporary) is planned after 3–6 months, depending on the patient’s condition.

Most patients resume normal activities within 4–8 weeks, with laparoscopic patients recovering faster (4–6 weeks). Survival rates exceed 80–90% with prompt surgery, though outcomes depend on the cause (e.g., better for peptic ulcers than advanced cancer) and patient’s health.