Background
Neonatal intestinal perforation is one condition with a high mortality rate (1). Its etiologies vary with necrotizing enterocolitis being the most common at 43.8%. Amongst others include Jejunoileal atresia which initially presents with intestinal obstruction, while toddlers and infants may have intussusception causing an intestinal obstruction as well but a rare phenomenon (2,3). A systematic review by Sebastian et al, the burden of intestinal atresia was at 54.9% in the studies of neonatal surgical conditions in Africa with highest mortality >50% in emergency neonatal surgery (4). In a retrospective review of babies who had laparotomy for jejunoileal atresia, 69.8% had ileal atresia and of those, 20.9% had type 1 atresia, meconium peritonitis was in 43.3% of the cases and was considered to be secondary to perforation (5). A non-NEC-related perforation can be idiopathic, secondary to any underlying pathology or a spontaneous perforation occurring in a normal bowel without any evident cause(6). In Intestinal obstruction as an underlying pathology mostly presents with abdominal distension and vomiting for 3 to 4 days in 74% of the neonates and commonly affected part of the bowel is the terminal ileum and neonatal gastrointestinal perforation may present with failure to pass meconium, vomiting, abdominal distension and pneumoperitoneum (6,7).
A plain radiograph of abdomen continues to be a useful tool for the diagnosis of neonatal intestinal obstruction demonstrating distended bowel loop or double bubble in proximal obstruction secondary to duodenal atresia (8,9)
The management of neonatal intestinal perforation depends on the aetiological factor and varies to include primary repair, resection and anastomoses, ileostomy, colostomy, gastrectomy and gastroduodenostomy (10–12). Though, Hiller et al reported neonates with ileal atresia who undergo primary resection and anastomosis had a better outcome than those who had secondary anastomosis, mortality and major complications are seen in neonates managed with primary anastomoses compared to ileostomy (13,14)