Approach to the Patient with a Gastrointestinal Perforation

Luminal perforations are among the most feared adverse events in endoscopy. Historically, all perforations were assumed to require surgical management. However, the expansion of endoscopic devices and techniques has revolutionized the management of gastrointestinal defects, providing an alternative to surgery with less morbidity. Several factors dictate management including the site of perforation, size of the defect, available expertise, timing of gastrointestinal wall defect recognition, and patient-specific comorbidities. An individualized approach for each patient is typically required based on these factors. In this article, we will discuss the general principles and approach for the management of patients with gastrointestinal perforation.