CLINICAL APPROACHES TO GASTROINTESTINAL PERFORATIONS: UPDATES ON DIAGNOSIS AND TREATMENT

Abstract

Gastrointestinal perforations are potentially life-threatening surgical emergencies characterized by a breach in the gastrointestinal tract wall and the subsequent leakage of contents into the peritoneal cavity. This condition can rapidly progress to peritonitis, sepsis, shock, and multiple organ dysfunction. Common etiologies include peptic ulcer disease, diverticulitis, neoplasms, ischemia, trauma, and iatrogenic complications. In this context, advances in diagnostic methods and surgical techniques have enabled earlier and more personalized interventions. Objective: To analyze scientific evidence regarding updates in the diagnosis and surgical treatment of gastrointestinal perforations, emphasizing strategies to reduce morbidity and mortality. Methods: This is a narrative literature review conducted using the PubMed, SciELO, Virtual Health Library (VHL), and Cochrane Library databases. Articles published between 2019 and 2025 in Portuguese and English were included, along with international guidelines on gastrointestinal perforations. The selected studies underwent qualitative and descriptive analysis. Results: Evidence indicates that early diagnosis—based on clinical assessment and computed tomography—is crucial for achieving better outcomes. Treatment involves hemodynamic stabilization, broad-spectrum antibiotic therapy, and early control of the source of infection. Laparotomy remains essential for unstable patients presenting with diffuse peritonitis or extensive abdominal contamination. However, laparoscopic approaches have yielded favorable results in selected patients, offering benefits such as reduced surgical trauma, less pain, a lower incidence of wound complications, and faster recovery. Endoscopic techniques are also increasingly being applied in cases of selected and iatrogenic perforations. Conclusion: The management of gastrointestinal perforations requires rapid diagnosis, clinical stabilization, and adequate control of the source of the perforation. The incorporation of minimally invasive techniques expands therapeutic possibilities; however, the choice of approach must consider the location and extent of the perforation, hemodynamic stability, the degree of contamination, and the team's experience, with the aim of reducing complications and mortality.