by EBSCO Medical Review Board
(Perforated Colon; Puncture of Colon)


A colon perforation is a puncture, cut, or tear in the wall of the colon (large intestine). This can cause air and intestinal material to leak into the abdomen.

Normal Colon
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Causes may be:

  • Trauma
  • Pressure against a weakened area of intestine
  • A breakdown of the intestinal wall by infection or disease

Risk Factors

This problem is more common in people who have had a procedure on the colon.

Certain health problems can also weaken the walls of the colon and raise the risk, such as:


Problems may be:

  • Severe belly pain
  • Fever
  • Bloody stool


A perforation may be seen during a procedure. Any problems that happen shortly after it may also be enough to suspect this health problem.

People who have not had a recent procedure will be asked about their symptoms and health history. A physical exam will be done.

Blood tests may be done to look for any signs of infection.

Images may be taken to look for signs of a leak. This may be done with:


Smaller perforations may heal on their own. The doctor will watch for any changes.

Surgery is needed to repair larger perforations and clean any materials that have leaked. More surgery may be also be needed to treat any related damage.

A serious infection can happen from an intestinal leak. Antibiotics may be given to treat it.


This problem may be caused by accidents. These are hard to prevent.

It may also be caused by some intestinal disorders. Managing these problems may lower the risk.


American Society for Gastrointestinal Endoscopy 

National Institute of Diabetes and Digestive and Kidney Diseases 


Canadian Association of Radiologists 

Public Health Agency of Canada 


Acute perforation of the gastrointestinal tract. Merck Manual Professional Version website. Available at: Accessed February 8, 2021.

Colonoscopy. American Gastroenterological Association website. Available at: Accessed February 8, 2021.

de'Angelis N, Di Saverio S, et al. 2017 WSES guidelines for the management of iatrogenic colonoscopy perforation. World J Emerg Surg. 2018;13:5.

Iatrogenic gastrointestinal tract perforation in adults. EBSCO DynaMed website. Available at: Accessed February 8, 2021.

Revision Information