Spontaneous perforation of the colon in the newborn infant.

If one excludes those cases of perforation which are secondary to volvulus, intestinal atresia, congenital bands, intussusception, herniation of the bowel, meconium ileus or Hirschsprung's disease, there remains a group of newborn infants who develop perforation of the colon without apparent cause. Spontaneous perforation of the colon in the neonate was first described by Breslau in 1863. It is a rare event and up until 1939 only 26 case reports could be traced in the medical literature by Thelander. A number of factors have been considered in the aetiology of spontaneous perforation such as trauma during delivery (Zillner, 1884), congenital defects of the bowel with diverticulum formation (Fischer, 1928), localized vascular insufficiency, and intrauterine or post-partum infection (Thelander, 1939). In 1888 Paltauf reported five cases which he attributed to coprostasis. This aetiological concept has recently received support from the clinico-surgical and pathological studies by Zachary (1957) and Emery (1957) of a group of newborn infants in whom inspissated faecal plugs gave rise to stercoral ulceration with perforation. These authors suggest that the observed faecal impaction may be due to an imbalance between fluid absorption and of propulsion of material along the colon. More recently Haas (1958) has reported a newborn infant with perforation of the transverse colon in whom a haemangiomatous abnormality at the site of perforation was demonstrated. There still remains a group of newborn infants with one or more perforations of the colon and in whom no clear cut cause can be discovered. In this paper two further cases of spontaneous perforation of the colon are reported. In one of these, perforation occurred during or immediately after birth and this was associated with marked intraperitoneal haemorrhage. The cause of the perforation was undetermined. The other child was a premature infant who developed the perforation nine days after delivery and histological examination showed fungal infection at the site of perforation.