High dosage use without food may arise upper gastrointestinal complications (like stomach bleeding, esophageal perforation, etc).

It is a hole

Increasing rigidity and tenderness indicates an increased likelihood of perforation and peritonitis.

The purpose of perforation depending on what one is talking about. In the case of oil well, the purpose of perforation is to allow the oil or gas to flow more easily to the wellbore to get it out of the ground.

Perforation means that there is a hole of some size in some organ ~ See related link below to several examples as to how the word "Perforation" is applied to a medical setting .