Perforation
A hole formed through the wall of a hollow organ or structure.
What it means
Perforation is a full-thickness hole through the wall of a hollow organ.
Its seriousness varies enormously by site. Perforation of the gastrointestinal tract allows contents to escape into the abdominal cavity, producing peritonitis — a surgical emergency. Perforation of an eardrum, by contrast, usually heals spontaneously.
Causes include ulceration, inflammation, obstruction, trauma and instrumentation during procedures.
In practice
Free air under the diaphragm on an erect chest X-ray, or free gas on CT, is the classic radiological sign of gastrointestinal perforation.
Diverticular disease, peptic ulcer and appendicitis are among the commonest causes.
Why it matters
Sudden severe abdominal pain with a rigid, board-like abdomen too painful to touch is perforation until proven otherwise, and requires emergency assessment.
Non-steroidal anti-inflammatory drugs and opioids both increase the risk of perforation in diverticular disease, which is why paracetamol is preferred for that condition.
Clinically reviewed by Dr Mohammad Zubair Khan, GMC 7563469
Last reviewed
August 30, 2026