title: Spontaneous intestinal perforation and Candida peritonitis presenting as extensive necrotizing enterocolitis.
abstract: Spontaneous intestinal perforation (SIP) has been increasingly reported in very-low-birthweight (VLBW) infants, although it is still less common than necrotizing enterocolitis (NEC). In around one-third of cases, SIP is associated with systemic candidiasis. We describe a case of SIP and Candida peritonitis in a VLBW infant, which was mistakenly diagnosed as NEC during the infant's short life. At laparotomy, the bowel surface was black and thought to be necrotic. As the infant was thought to have whole-bowel necrosis due to NEC, her condition was deemed incompatible with survival. At postmortem, however, the bowel wall was found to be healthy apart from a very localized patch of necrosis associated with a single perforation. The bowel was covered by a thick, black, serosal exudate consisting of fungal elements from Candida albicans.
  
  
  CONCLUSIONS
  This case reinforces the fact that a markedly discoloured bowel is not necessarily necrotic and that the discoloration can potentially recover.
authors.affiliation: Department of Paediatrics, Faculty of Medicine, Imperial College School of Science, Technology and Medicine, Hammersmith Hospital, London, UK. n.robertson@ic.ac.uk
authors.forename: N J
authors.initials: NJ
authors.lastname: Robertson
authors.forename: J
authors.initials: J
authors.lastname: Kuna
authors.forename: P M
authors.initials: PM
authors.lastname: Cox
authors.forename: K
authors.initials: K
authors.lastname: Lakhoo
mesh_terms: D000328:Adult; D002177:Candidiasis / Q000150:complications* / Q000175:diagnosis* / Q000601:surgery; D003937:Diagnosis, Differential; D020345:Enterocolitis, Necrotizing / Q000175:diagnosis* / Q000209:etiology* / Q000601:surgery; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D019102:Infant, Very Low Birth Weight; D007416:Intestinal Perforation / Q000175:diagnosis* / Q000209:etiology* / Q000601:surgery; D008297:Male; D010538:Peritonitis / Q000150:complications* / Q000175:diagnosis* / Q000601:surgery; D011247:Pregnancy; D012422:Rupture, Spontaneous / Q000175:diagnosis / Q000209:etiology / Q000601:surgery; D014427:Twins