Bowel perforation - Revision history

Danbot: Strip excess bold

2026-03-22T09:29:29Z

Strip excess bold

Ostermayer: Marked this version for translation

2026-01-07T12:25:02Z

Marked this version for translation

← Older revision		Revision as of 12:25, 7 January 2026
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	<translate>		<translate>

	==Background==		==Background== <!--T:1-->

			<!--T:2-->
	[[File:Blausen 0817 SmallIntestine Anatomy.png \|thumb\|Illustration of GI track]]		[[File:Blausen 0817 SmallIntestine Anatomy.png \|thumb\|Illustration of GI track]]
	*Definition: a full-thickness breach of the intestinal wall, allowing air and/or gastrointestinal contents to enter the surrounding peritoneal cavity		*Definition: a full-thickness breach of the intestinal wall, allowing air and/or gastrointestinal contents to enter the surrounding peritoneal cavity
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	===Causes<ref>Sabiston, David C.,Townsend, Courtney M.,eds. Sabiston Textbook Of Surgery: The Biological Basis Of Modern Surgical Practice. Philadelphia, PA : Elsevier Saunders, 2012.</ref><ref>Tanner, T., Hall, B., & Oran, J. (2018). Pneumoperitoneum. Surgical Clinics of North America., 98(5), 915–932. https://doi.org/10.1016/j.suc.2018.06.004.</ref>===		===Causes<ref>Sabiston, David C.,Townsend, Courtney M.,eds. Sabiston Textbook Of Surgery: The Biological Basis Of Modern Surgical Practice. Philadelphia, PA : Elsevier Saunders, 2012.</ref><ref>Tanner, T., Hall, B., & Oran, J. (2018). Pneumoperitoneum. Surgical Clinics of North America., 98(5), 915–932. https://doi.org/10.1016/j.suc.2018.06.004.</ref>=== <!--T:3-->

			<!--T:4-->
	* [[Special:MyLanguage/Peptic ulcer disease\|Peptic ulcer disease]]		* [[Special:MyLanguage/Peptic ulcer disease\|Peptic ulcer disease]]
	* Malignancy		* Malignancy
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	==Clinical Features==		==Clinical Features== <!--T:5-->



	===Primary Features===		===Primary Features=== <!--T:6-->

			<!--T:7-->
	;History		;History
	*[[Special:MyLanguage/Abdominal pain\|Abdominal pain]], abdominal distention / rigidity		*[[Special:MyLanguage/Abdominal pain\|Abdominal pain]], abdominal distention / rigidity
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	*[[Special:MyLanguage/Nausea\|Nausea]], [[Special:MyLanguage/vomiting\|vomiting]], [[Special:MyLanguage/fever\|fever]], and anorexia often present		*[[Special:MyLanguage/Nausea\|Nausea]], [[Special:MyLanguage/vomiting\|vomiting]], [[Special:MyLanguage/fever\|fever]], and anorexia often present

			<!--T:8-->
	;Physical exam		;Physical exam
	* Perforation with [[Special:MyLanguage/peritonitis\|peritonitis]]		* Perforation with [[Special:MyLanguage/peritonitis\|peritonitis]]
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	===Secondary Features===		===Secondary Features=== <!--T:9-->

			<!--T:10-->
	*[[Special:MyLanguage/Sepsis\|Sepsis]] ([[Special:MyLanguage/fever\|fever]], [[Special:MyLanguage/leukocytosis\|leukocytosis]], [[Special:MyLanguage/tachycardia\|tachycardia]], [[Special:MyLanguage/hypotension\|hypotension]])		*[[Special:MyLanguage/Sepsis\|Sepsis]] ([[Special:MyLanguage/fever\|fever]], [[Special:MyLanguage/leukocytosis\|leukocytosis]], [[Special:MyLanguage/tachycardia\|tachycardia]], [[Special:MyLanguage/hypotension\|hypotension]])
	*Possible [[Special:MyLanguage/sepsis\|sepsis]]-related end-organ dysfunction (i.e., [[Special:MyLanguage/ARDS\|ARDS]], [[Special:MyLanguage/renal failure\|renal failure]])		*Possible [[Special:MyLanguage/sepsis\|sepsis]]-related end-organ dysfunction (i.e., [[Special:MyLanguage/ARDS\|ARDS]], [[Special:MyLanguage/renal failure\|renal failure]])


	==Differential Diagnosis==		==Differential Diagnosis== <!--T:11-->

			<!--T:12-->
	* [[Special:MyLanguage/Acute myocardial infarction\|Acute myocardial infarction]]		* [[Special:MyLanguage/Acute myocardial infarction\|Acute myocardial infarction]]
	* [[Special:MyLanguage/Intestinal obstruction\|Intestinal obstruction]]		* [[Special:MyLanguage/Intestinal obstruction\|Intestinal obstruction]]
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	==Evaluation<ref>Sabiston, David C.,Townsend, Courtney M.,eds. Sabiston Textbook Of Surgery: The Biological Basis Of Modern Surgical Practice. Philadelphia, PA : Elsevier Saunders, 2012.</ref><ref>Tanner, T., Hall, B., & Oran, J. (2018). Pneumoperitoneum. Surgical Clinics of North America., 98(5), 915–932. https://doi.org/10.1016/j.suc.2018.06.004.</ref>==		==Evaluation<ref>Sabiston, David C.,Townsend, Courtney M.,eds. Sabiston Textbook Of Surgery: The Biological Basis Of Modern Surgical Practice. Philadelphia, PA : Elsevier Saunders, 2012.</ref><ref>Tanner, T., Hall, B., & Oran, J. (2018). Pneumoperitoneum. Surgical Clinics of North America., 98(5), 915–932. https://doi.org/10.1016/j.suc.2018.06.004.</ref>== <!--T:13-->

			<!--T:14-->
	[[File:Free air2010.png\|thumb\|Free air under the right diaphragm from a perforated bowel.]]		[[File:Free air2010.png\|thumb\|Free air under the right diaphragm from a perforated bowel.]]
	[[File:sub free gas.jpg\|thumb\|Subdiaphragmatic free gas. <ref>Case courtesy of Dr Rahul Kulkarni, https://radiopaedia.org/">Radiopaedia.org</a>. From the case <a href="https://radiopaedia.org/cases/21444">rID: 21444</ref>.]]		[[File:sub free gas.jpg\|thumb\|Subdiaphragmatic free gas. <ref>Case courtesy of Dr Rahul Kulkarni, https://radiopaedia.org/">Radiopaedia.org</a>. From the case <a href="https://radiopaedia.org/cases/21444">rID: 21444</ref>.]]
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	[[File:duodenal perf.jpg\|thumb\|Duodenal perforation.<ref>Case courtesy of Dr Ian Bickle, "https://radiopaedia.org/">Radiopaedia.org</a>. From the case <a href="https://radiopaedia.org/cases/55491">rID: 55491</ref>.]]		[[File:duodenal perf.jpg\|thumb\|Duodenal perforation.<ref>Case courtesy of Dr Ian Bickle, "https://radiopaedia.org/">Radiopaedia.org</a>. From the case <a href="https://radiopaedia.org/cases/55491">rID: 55491</ref>.]]

	===Workup===		===Workup=== <!--T:15-->

			<!--T:16-->
	*CBC, BMP, PT/PTT, [[Special:MyLanguage/LFTs\|LFTs]], lipase, T&S		*CBC, BMP, PT/PTT, [[Special:MyLanguage/LFTs\|LFTs]], lipase, T&S
	*Blood cultures (as long as this does not delay the initiation of antimicrobial therapy)		*Blood cultures (as long as this does not delay the initiation of antimicrobial therapy)
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	===Diagnosis===		===Diagnosis=== <!--T:17-->

			<!--T:18-->
	* Physical exam vs. imaging		* Physical exam vs. imaging


	==Management==		==Management== <!--T:19-->


	===General Treatment===		===General Treatment=== <!--T:20-->

			<!--T:21-->
	*NPO<ref>Sabiston, David C.,Townsend, Courtney M.,eds. Sabiston Textbook Of Surgery: The Biological Basis Of Modern Surgical Practice. Philadelphia, PA : Elsevier Saunders, 2012.</ref>		*NPO<ref>Sabiston, David C.,Townsend, Courtney M.,eds. Sabiston Textbook Of Surgery: The Biological Basis Of Modern Surgical Practice. Philadelphia, PA : Elsevier Saunders, 2012.</ref>
	*Surgical consult<ref>Sabiston, David C.,Townsend, Courtney M.,eds. Sabiston Textbook Of Surgery: The Biological Basis Of Modern Surgical Practice. Philadelphia, PA : Elsevier Saunders, 2012.</ref>		*Surgical consult<ref>Sabiston, David C.,Townsend, Courtney M.,eds. Sabiston Textbook Of Surgery: The Biological Basis Of Modern Surgical Practice. Philadelphia, PA : Elsevier Saunders, 2012.</ref>
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	===Broad-Spectrum [[Special:MyLanguage/Antibiotics\|Antibiotics]]<ref>Joseph S. Solomkin, John E. Mazuski, John S. Bradley, Keith A Rodvold, Ellie J.C. Goldstein, Ellen J. Baron, Patrick J. O'Neill, Anthony W. Chow, E. Patchen Dellinger, Soumitra R. Eachempati, Sherwood Gorbach, Mary Hilfiker, Addison K. May, Avery B. Nathens, Robert G. Sawyer, John G. Bartlett, Diagnosis and Management of Complicated Intra-abdominal Infection in Adults and Children: Guidelines by the Surgical Infection Society and the Infectious Diseases Society of America, Clinical Infectious Diseases, Volume 50, Issue 2, 15 January 2010, Pages 133–164, https://doi.org/10.1086/649554.</ref>===		===Broad-Spectrum [[Special:MyLanguage/Antibiotics\|Antibiotics]]<ref>Joseph S. Solomkin, John E. Mazuski, John S. Bradley, Keith A Rodvold, Ellie J.C. Goldstein, Ellen J. Baron, Patrick J. O'Neill, Anthony W. Chow, E. Patchen Dellinger, Soumitra R. Eachempati, Sherwood Gorbach, Mary Hilfiker, Addison K. May, Avery B. Nathens, Robert G. Sawyer, John G. Bartlett, Diagnosis and Management of Complicated Intra-abdominal Infection in Adults and Children: Guidelines by the Surgical Infection Society and the Infectious Diseases Society of America, Clinical Infectious Diseases, Volume 50, Issue 2, 15 January 2010, Pages 133–164, https://doi.org/10.1086/649554.</ref>=== <!--T:22-->

			<!--T:23-->
	''Start as soon as possible; ideally within the first hour''		''Start as soon as possible; ideally within the first hour''
	* Community-acquired:		* Community-acquired:
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	==Disposition==		==Disposition== <!--T:24-->

			<!--T:25-->
	* Admission (typically directly to operating room)<ref>Sabiston, David C.,Townsend, Courtney M.,eds. Sabiston Textbook Of Surgery: The Biological Basis Of Modern Surgical Practice. Philadelphia, PA : Elsevier Saunders, 2012.</ref>		* Admission (typically directly to operating room)<ref>Sabiston, David C.,Townsend, Courtney M.,eds. Sabiston Textbook Of Surgery: The Biological Basis Of Modern Surgical Practice. Philadelphia, PA : Elsevier Saunders, 2012.</ref>


	==See Also==		==See Also== <!--T:26-->

			<!--T:27-->
	*[[Special:MyLanguage/Sepsis\|Sepsis]]		*[[Special:MyLanguage/Sepsis\|Sepsis]]


	==External Links==		==External Links== <!--T:28-->


	==References==		==References== <!--T:29-->

			<!--T:30-->
	<references/>		<references/>

			<!--T:31-->
	[[Category:Surgery]]		[[Category:Surgery]]
	[[Category:GI]]		[[Category:GI]]
	</translate>		</translate>

Ostermayer: Prepared the page for translation

2026-01-04T21:45:37Z

Prepared the page for translation

Show changes

Rossdonaldson1 at 00:44, 1 February 2024

2024-02-01T00:44:52Z

← Older revision		Revision as of 00:44, 1 February 2024
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	==Background==		==Background==
	[[File:Blausen 0817 SmallIntestine Anatomy.png \|thumb\|]]		[[File:Blausen 0817 SmallIntestine Anatomy.png \|thumb\|Illustration of GI track]]
	*Definition: a full-thickness breach of the intestinal wall, allowing air and/or gastrointestinal contents to enter the surrounding peritoneal cavity		*Definition: a full-thickness breach of the intestinal wall, allowing air and/or gastrointestinal contents to enter the surrounding peritoneal cavity
	*Can be a potentially life-threatening cause of [[sepsis]]		*Can be a potentially life-threatening cause of [[sepsis]]

Rossdonaldson1: /* Background */

2024-02-01T00:43:50Z

Background

← Older revision		Revision as of 00:43, 1 February 2024
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	==Background==		==Background==
			[[File:Blausen 0817 SmallIntestine Anatomy.png \|thumb\|]]
	*Definition: a full-thickness breach of the intestinal wall, allowing air and/or gastrointestinal contents to enter the surrounding peritoneal cavity		*Definition: a full-thickness breach of the intestinal wall, allowing air and/or gastrointestinal contents to enter the surrounding peritoneal cavity
	*Can be a potentially life-threatening cause of [[sepsis]]		*Can be a potentially life-threatening cause of [[sepsis]]

Rossdonaldson1: /* EvaluationSabiston, David C.,Townsend, Courtney M.,eds. Sabiston Textbook Of Surgery: The Biological Basis Of Modern Surgical Practice. Philadelphia, PA : Elsevier Saunders, 2012.Tanner, T., Hall, B., & Oran, J. (2018). Pneumoperitoneum. Surgical Clinics of North America., 98(5), 915–932. https://doi.org/10.1016/j.suc.2018.06.004. */

2022-09-07T15:57:58Z

EvaluationSabiston, David C.,Townsend, Courtney M.,eds. Sabiston Textbook Of Surgery: The Biological Basis Of Modern Surgical Practice. Philadelphia, PA : Elsevier Saunders, 2012.Tanner, T., Hall, B., & Oran, J. (2018). Pneumoperitoneum. Surgical Clinics of North America., 98(5), 915–932. https://doi.org/10.1016/j.suc.2018.06.004.

← Older revision		Revision as of 15:57, 7 September 2022
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	==Evaluation<ref>Sabiston, David C.,Townsend, Courtney M.,eds. Sabiston Textbook Of Surgery: The Biological Basis Of Modern Surgical Practice. Philadelphia, PA : Elsevier Saunders, 2012.</ref><ref>Tanner, T., Hall, B., & Oran, J. (2018). Pneumoperitoneum. Surgical Clinics of North America., 98(5), 915–932. https://doi.org/10.1016/j.suc.2018.06.004.</ref>==		==Evaluation<ref>Sabiston, David C.,Townsend, Courtney M.,eds. Sabiston Textbook Of Surgery: The Biological Basis Of Modern Surgical Practice. Philadelphia, PA : Elsevier Saunders, 2012.</ref><ref>Tanner, T., Hall, B., & Oran, J. (2018). Pneumoperitoneum. Surgical Clinics of North America., 98(5), 915–932. https://doi.org/10.1016/j.suc.2018.06.004.</ref>==
			[[File:Free air2010.png\|thumb\|Free air under the right diaphragm from a perforated bowel.]]
	[[File:sub free gas.jpg\|thumb\|Subdiaphragmatic free gas. <ref>Case courtesy of Dr Rahul Kulkarni, https://radiopaedia.org/">Radiopaedia.org</a>. From the case <a href="https://radiopaedia.org/cases/21444">rID: 21444</ref>.]]		[[File:sub free gas.jpg\|thumb\|Subdiaphragmatic free gas. <ref>Case courtesy of Dr Rahul Kulkarni, https://radiopaedia.org/">Radiopaedia.org</a>. From the case <a href="https://radiopaedia.org/cases/21444">rID: 21444</ref>.]]
	[[File:large bowel perf.jpg\|thumb\|Large bowel perforation.<ref>Case courtesy of Dr Ian Bickle, "https://radiopaedia.org/">Radiopaedia.org</a>. From the case < href="https://radiopaedia.org/cases/55375">rID: 55375</ref>.]]		[[File:large bowel perf.jpg\|thumb\|Large bowel perforation.<ref>Case courtesy of Dr Ian Bickle, "https://radiopaedia.org/">Radiopaedia.org</a>. From the case < href="https://radiopaedia.org/cases/55375">rID: 55375</ref>.]]

Rossdonaldson1: /* ManagementSabiston, David C.,Townsend, Courtney M.,eds. Sabiston Textbook Of Surgery: The Biological Basis Of Modern Surgical Practice. Philadelphia, PA : Elsevier Saunders, 2012.Rhodes, A., Evans, L.E., Alhazzani, W. et al. Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016. Intensive Care Med 43, 304–377 (2017). https://doi.org/10.1007/s00134-017-4683-6.Joseph S. Solomkin, John E. Mazuski, John S. Bradley, Keith A Rodvold, Ellie J.C. Golds...

2022-09-07T15:42:34Z

/* ManagementSabiston, David C.,Townsend, Courtney M.,eds. Sabiston Textbook Of Surgery: The Biological Basis Of Modern Surgical Practice. Philadelphia, PA : Elsevier Saunders, 2012.Rhodes, A., Evans, L.E., Alhazzani, W. et al. Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016. Intensive Care Med 43, 304–377 (2017). https://doi.org/10.1007/s00134-017-4683-6.Joseph S. Solomkin, John E. Mazuski, John S. Bradley, Keith A Rodvold, Ellie J.C. Golds...

← Older revision		Revision as of 15:42, 7 September 2022
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	* Physical exam vs. imaging		* Physical exam vs. imaging

	==Management<ref>Sabiston, David C.,Townsend, Courtney M.,eds. Sabiston Textbook Of Surgery: The Biological Basis Of Modern Surgical Practice. Philadelphia, PA : Elsevier Saunders, 2012.</ref><ref>Rhodes, A., Evans, L.E., Alhazzani, W. et al. Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016. Intensive Care Med 43, 304–377 (2017). https://doi.org/10.1007/s00134-017-4683-6.</ref><ref>Joseph S. Solomkin, John E. Mazuski, John S. Bradley, Keith A Rodvold, Ellie J.C. Goldstein, Ellen J. Baron, Patrick J. O'Neill, Anthony W. Chow, E. Patchen Dellinger, Soumitra R. Eachempati, Sherwood Gorbach, Mary Hilfiker, Addison K. May, Avery B. Nathens, Robert G. Sawyer, John G. Bartlett, Diagnosis and Management of Complicated Intra-abdominal Infection in Adults and Children: Guidelines by the Surgical Infection Society and the Infectious Diseases Society of America, Clinical Infectious Diseases, Volume 50, Issue 2, 15 January 2010, Pages 133–164, https://doi.org/10.1086/649554.</ref>==		==Management==
	===General Treatment===		===General Treatment===
	*NPO<ref>Sabiston, David C.,Townsend, Courtney M.,eds. Sabiston Textbook Of Surgery: The Biological Basis Of Modern Surgical Practice. Philadelphia, PA : Elsevier Saunders, 2012.</ref>		*NPO<ref>Sabiston, David C.,Townsend, Courtney M.,eds. Sabiston Textbook Of Surgery: The Biological Basis Of Modern Surgical Practice. Philadelphia, PA : Elsevier Saunders, 2012.</ref>

Rossdonaldson1: /* DispositionSabiston, David C.,Townsend, Courtney M.,eds. Sabiston Textbook Of Surgery: The Biological Basis Of Modern Surgical Practice. Philadelphia, PA : Elsevier Saunders, 2012. */

2022-09-07T15:41:50Z

DispositionSabiston, David C.,Townsend, Courtney M.,eds. Sabiston Textbook Of Surgery: The Biological Basis Of Modern Surgical Practice. Philadelphia, PA : Elsevier Saunders, 2012.

← Older revision		Revision as of 15:41, 7 September 2022
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	* '''Fungal infection''': Antifungal therapy for patients with severe community-acquired or health care-associated infection is recommended if candida is grown from intra-abdominal cultures ([[fluconazole]]; echinocandins for triazole-resistant species)		* '''Fungal infection''': Antifungal therapy for patients with severe community-acquired or health care-associated infection is recommended if candida is grown from intra-abdominal cultures ([[fluconazole]]; echinocandins for triazole-resistant species)

	==Disposition<ref>Sabiston, David C.,Townsend, Courtney M.,eds. Sabiston Textbook Of Surgery: The Biological Basis Of Modern Surgical Practice. Philadelphia, PA : Elsevier Saunders, 2012.</ref>==		==Disposition==
	* Obtain immediate surgical consult		* Admission (typically directly to operating room)<ref>Sabiston, David C.,Townsend, Courtney M.,eds. Sabiston Textbook Of Surgery: The Biological Basis Of Modern Surgical Practice. Philadelphia, PA : Elsevier Saunders, 2012.</ref>

	==See Also==		==See Also==

Rossdonaldson1: /* References */

2022-09-07T15:40:24Z

References

← Older revision		Revision as of 15:40, 7 September 2022
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	==References==		==References==
	<references/>		<references/>
	~~# Sabiston, David C.,Townsend, Courtney M.,eds. Sabiston Textbook Of Surgery: The Biological Basis Of Modern Surgical Practice. Philadelphia, PA : Elsevier Saunders, 2012.~~
	~~# Tanner, T., Hall, B., & Oran, J. (2018). Pneumoperitoneum. Surgical Clinics of North America., 98(5), 915–932. https://doi.org/10.1016/j.suc.2018.06.004.~~
	# Rhodes, A., Evans, L.E., Alhazzani, W. et al. Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016. Intensive Care Med 43, 304–377 (2017). https://doi.org/10.1007/s00134-017-4683-6.
	# Joseph S. Solomkin, John E. Mazuski, John S. Bradley, Keith A Rodvold, Ellie J.C. Goldstein, Ellen J. Baron, Patrick J. O'Neill, Anthony W. Chow, E. Patchen Dellinger, Soumitra R. Eachempati, Sherwood Gorbach, Mary Hilfiker, Addison K. May, Avery B. Nathens, Robert G. Sawyer, John G. Bartlett, Diagnosis and Management of Complicated Intra-abdominal Infection in Adults and Children: Guidelines by the Surgical Infection Society and the Infectious Diseases Society of America, Clinical Infectious Diseases, Volume 50, Issue 2, 15 January 2010, Pages 133–164, https://doi.org/10.1086/649554.

	[[Category:Surgery]]		[[Category:Surgery]]
	[[Category:GI]]		[[Category:GI]]

Tiffieau: /* CausesSabiston, David C.,Townsend, Courtney M.,eds. Sabiston Textbook Of Surgery: The Biological Basis Of Modern Surgical Practice. Philadelphia, PA : Elsevier Saunders, 2012.Tanner, T., Hall, B., & Oran, J. (2018). Pneumoperitoneum. Surgical Clinics o

2022-09-06T01:11:46Z

/* CausesSabiston, David C.,Townsend, Courtney M.,eds. Sabiston Textbook Of Surgery: The Biological Basis Of Modern Surgical Practice. Philadelphia, PA : Elsevier Saunders, 2012.Tanner, T., Hall, B., & Oran, J. (2018). Pneumoperitoneum. Surgical Clinics o

← Older revision		Revision as of 01:11, 6 September 2022
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	* [[Abdominal trauma]] (penetrating > blunt)		* [[Abdominal trauma]] (penetrating > blunt)
	* [[Bowel obstruction]]		* [[Bowel obstruction]]
			* [[Intestinal ischemia]]
	* [[Foreign body ingestion]]		* [[Foreign body ingestion]]
	* [[Necrotizing enterocolitis]] (premature infants)		* [[Necrotizing enterocolitis]] (premature infants)

← Older revision		Revision as of 09:29, 22 March 2026
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	** Therapy should target enteric gram-negative aerobic and facultative bacilli, obligate anaerobic bacilli, and enteric gram-positive streptococci		** Therapy should target enteric gram-negative aerobic and facultative bacilli, obligate anaerobic bacilli, and enteric gram-positive streptococci
	**Adult regimen:		**Adult regimen:
	***~~'''~~Mild to moderate severity community acquired GI perforation~~'''~~:		***Mild to moderate severity community acquired GI perforation:
	**** ~~'''~~Single agent~~'''~~: [[Special:MyLanguage/Cefoxitin\|Cefoxitin]], [[Special:MyLanguage/ertapenem\|ertapenem]], [[Special:MyLanguage/moxifloxacin\|moxifloxacin]], [[Special:MyLanguage/tigecycline\|tigecycline]], or [[Special:MyLanguage/ticarcillin/clavulanic acid\|ticarcillin/clavulanic acid]]		**** Single agent: [[Special:MyLanguage/Cefoxitin\|Cefoxitin]], [[Special:MyLanguage/ertapenem\|ertapenem]], [[Special:MyLanguage/moxifloxacin\|moxifloxacin]], [[Special:MyLanguage/tigecycline\|tigecycline]], or [[Special:MyLanguage/ticarcillin/clavulanic acid\|ticarcillin/clavulanic acid]]
	**** ~~'''~~Combination therapy~~'''~~:		**** Combination therapy:
	***** [[Special:MyLanguage/Cefazolin\|Cefazolin]], [[Special:MyLanguage/cefuroxime\|cefuroxime]], [[Special:MyLanguage/ceftriaxone\|ceftriaxone]], [[Special:MyLanguage/cefotaxime\|cefotaxime]], [[Special:MyLanguage/ciprofloxacin\|ciprofloxacin]], or [[Special:MyLanguage/levofloxacin\|levofloxacin]] -AND-		***** [[Special:MyLanguage/Cefazolin\|Cefazolin]], [[Special:MyLanguage/cefuroxime\|cefuroxime]], [[Special:MyLanguage/ceftriaxone\|ceftriaxone]], [[Special:MyLanguage/cefotaxime\|cefotaxime]], [[Special:MyLanguage/ciprofloxacin\|ciprofloxacin]], or [[Special:MyLanguage/levofloxacin\|levofloxacin]] -AND-
	***** [[Special:MyLanguage/Metronidazole\|Metronidazole]]		***** [[Special:MyLanguage/Metronidazole\|Metronidazole]]
	*** ~~'''~~High risk/severity community acquired GI perforation~~'''~~:		*** High risk/severity community acquired GI perforation:
	**** '''Single agent''': [[Special:MyLanguage/Imipenem-cilastatin\|Imipenem-cilastatin]], [[Special:MyLanguage/meropenem\|meropenem]], [[Special:MyLanguage/doripenem\|doripenem]], or [[Special:MyLanguage/piperacillin/tazobactam\|piperacillin/tazobactam]]		**** '''Single agent''': [[Special:MyLanguage/Imipenem-cilastatin\|Imipenem-cilastatin]], [[Special:MyLanguage/meropenem\|meropenem]], [[Special:MyLanguage/doripenem\|doripenem]], or [[Special:MyLanguage/piperacillin/tazobactam\|piperacillin/tazobactam]]
	**** ~~'''~~Combination therapy~~'''~~: [[Special:MyLanguage/Cefepime\|Cefepime]], [[Special:MyLanguage/ceftazidime\|ceftazidime]], [[Special:MyLanguage/ciprofloxacin\|ciprofloxacin]], or [[Special:MyLanguage/levofloxacin\|levofloxacin]] -AND-		**** Combination therapy: [[Special:MyLanguage/Cefepime\|Cefepime]], [[Special:MyLanguage/ceftazidime\|ceftazidime]], [[Special:MyLanguage/ciprofloxacin\|ciprofloxacin]], or [[Special:MyLanguage/levofloxacin\|levofloxacin]] -AND-
	**** [[Special:MyLanguage/Metronidazole\|Metronidazole]]		**** [[Special:MyLanguage/Metronidazole\|Metronidazole]]
	** Pediatric regimen:		** Pediatric regimen:
	*** ~~'''~~Community acquired GI perforation~~'''~~:		*** Community acquired GI perforation:
	**** '''Single agent''': [[Special:MyLanguage/Ertapenem\|Ertapenem]], [[Special:MyLanguage/meropenem\|meropenem]], [[Special:MyLanguage/imipenem-cilastatin\|imipenem-cilastatin]], [[Special:MyLanguage/ticarcillin/clavulanate\|ticarcillin/clavulanate]], and [[Special:MyLanguage/piperacillin/tazobactam\|piperacillin/tazobactam]]		**** '''Single agent''': [[Special:MyLanguage/Ertapenem\|Ertapenem]], [[Special:MyLanguage/meropenem\|meropenem]], [[Special:MyLanguage/imipenem-cilastatin\|imipenem-cilastatin]], [[Special:MyLanguage/ticarcillin/clavulanate\|ticarcillin/clavulanate]], and [[Special:MyLanguage/piperacillin/tazobactam\|piperacillin/tazobactam]]
	**** ~~'''~~Combination therapy~~'''~~:		**** Combination therapy:
	***** [[Special:MyLanguage/Ceftriaxone\|Ceftriaxone]], [[Special:MyLanguage/cefotaxime\|cefotaxime]], [[Special:MyLanguage/cefepime\|cefepime]], or [[Special:MyLanguage/ceftazidime\|ceftazidime]], each in combination with [[Special:MyLanguage/metronidazole\|metronidazole]]		***** [[Special:MyLanguage/Ceftriaxone\|Ceftriaxone]], [[Special:MyLanguage/cefotaxime\|cefotaxime]], [[Special:MyLanguage/cefepime\|cefepime]], or [[Special:MyLanguage/ceftazidime\|ceftazidime]], each in combination with [[Special:MyLanguage/metronidazole\|metronidazole]]
	***** [[Special:MyLanguage/Gentamicin\|Gentamicin]] or [[Special:MyLanguage/tobramycin\|tobramycin]], each in combination with [[Special:MyLanguage/metronidazole\|metronidazole]] or [[Special:MyLanguage/clindamycin\|clindamycin]], and with or without [[Special:MyLanguage/ampicillin\|ampicillin]]		***** [[Special:MyLanguage/Gentamicin\|Gentamicin]] or [[Special:MyLanguage/tobramycin\|tobramycin]], each in combination with [[Special:MyLanguage/metronidazole\|metronidazole]] or [[Special:MyLanguage/clindamycin\|clindamycin]], and with or without [[Special:MyLanguage/ampicillin\|ampicillin]]
	* Iatrogenic/hospital-associated perforation: Therapy should be driven by local microbiologic results.		* Iatrogenic/hospital-associated perforation: Therapy should be driven by local microbiologic results.
	** Drug-resistant bacteria regimen (common in hospital-associated perforation):		** Drug-resistant bacteria regimen (common in hospital-associated perforation):
	*** ~~'''~~<20% Resistant [[Special:MyLanguage/Pseudomonas aeruginosa\|Pseudomonas aeruginosa]], ESBL-producing [[Special:MyLanguage/Enterobacteriaceae\|Enterobacteriaceae]], [[Special:MyLanguage/Acinetobacter\|Acinetobacter]], or other MDR [[Special:MyLanguage/GNB\|GNB]]~~'''~~:		*** <20% Resistant [[Special:MyLanguage/Pseudomonas aeruginosa\|Pseudomonas aeruginosa]], ESBL-producing [[Special:MyLanguage/Enterobacteriaceae\|Enterobacteriaceae]], [[Special:MyLanguage/Acinetobacter\|Acinetobacter]], or other MDR [[Special:MyLanguage/GNB\|GNB]]:
	**** ~~'''~~Single agent~~'''~~: [[Special:MyLanguage/Carbapenem\|Carbapenem]], [[Special:MyLanguage/piperacillin-tazobactam\|piperacillin-tazobactam]]		**** Single agent: [[Special:MyLanguage/Carbapenem\|Carbapenem]], [[Special:MyLanguage/piperacillin-tazobactam\|piperacillin-tazobactam]]
	**** [[Special:MyLanguage/Ceftazidime\|Ceftazidime]] or [[Special:MyLanguage/cefepime\|cefepime]], each in combination with [[Special:MyLanguage/metronidazole\|metronidazole]]		**** [[Special:MyLanguage/Ceftazidime\|Ceftazidime]] or [[Special:MyLanguage/cefepime\|cefepime]], each in combination with [[Special:MyLanguage/metronidazole\|metronidazole]]
	*** ~~'''~~ESBL-producing [[Special:MyLanguage/Enterobacteriaceae\|Enterobacteriaceae]]~~'''~~: [[Special:MyLanguage/Carbapenem\|Carbapenem]], [[Special:MyLanguage/piperacillin/tazobactam\|piperacillin/tazobactam]], or [[Special:MyLanguage/aminoglycoside\|aminoglycoside]]		*** ESBL-producing [[Special:MyLanguage/Enterobacteriaceae\|Enterobacteriaceae]]: [[Special:MyLanguage/Carbapenem\|Carbapenem]], [[Special:MyLanguage/piperacillin/tazobactam\|piperacillin/tazobactam]], or [[Special:MyLanguage/aminoglycoside\|aminoglycoside]]
	*** ~~'''~~[[Special:MyLanguage/P. aeruginosa\|P. aeruginosa]] >20% resistant to [[Special:MyLanguage/ceftazidime\|ceftazidime]]~~'''~~: [[Special:MyLanguage/Carbapenem\|Carbapenem]], [[Special:MyLanguage/piperacillin/tazobactam\|piperacillin/tazobactam]], or [[Special:MyLanguage/aminoglycoside\|aminoglycoside]]		*** [[Special:MyLanguage/P. aeruginosa\|P. aeruginosa]] >20% resistant to [[Special:MyLanguage/ceftazidime\|ceftazidime]]: [[Special:MyLanguage/Carbapenem\|Carbapenem]], [[Special:MyLanguage/piperacillin/tazobactam\|piperacillin/tazobactam]], or [[Special:MyLanguage/aminoglycoside\|aminoglycoside]]
	*** ~~'''~~[[Special:MyLanguage/MRSA\|MRSA]]~~'''~~: [[Special:MyLanguage/Vancomycin\|Vancomycin]] only		*** [[Special:MyLanguage/MRSA\|MRSA]]: [[Special:MyLanguage/Vancomycin\|Vancomycin]] only
	* ~~'''~~Fungal infection~~'''~~: Antifungal therapy for patients with severe community-acquired or health care-associated infection is recommended if candida is grown from intra-abdominal cultures ([[Special:MyLanguage/fluconazole\|fluconazole]]; echinocandins for triazole-resistant species)		* Fungal infection: Antifungal therapy for patients with severe community-acquired or health care-associated infection is recommended if candida is grown from intra-abdominal cultures ([[Special:MyLanguage/fluconazole\|fluconazole]]; echinocandins for triazole-resistant species)