title: Characteristic Radiological findings in Preterm Infants with Missed Intestinal Perforation.
abstract: BACKGROUND
  Pneumoperitoneum on radiological imaging is typical in intestinal perforation in necrotizing enterocolitis [NEC]. However, it is not seen in all cases and intestinal perforation is missed on occasions. We present a series of preterm infants with characteristic x-ray findings that on exploration revealed missed intestinal perforation.
  
  
  METHODS
  Retrospective review of neonates with intra-operative diagnosis of intestinal perforation which was missed on x-ray abdomen over a period of 6 months is being presented here.
  
  
  RESULTS
  Three neonates born at 24 (24-30) weeks of gestation were identified. PDA was noted in all 3 patients and they required ventilator and inotropic support. Feeds were commenced at 5 (2-7) days of life. All three patients were treated for NEC. Surgical opinion was sought in view of localized gas shadow in a fixed position seen on repeated x-rays in all three patients. All three patients had laparotomy and small bowel resection with ileostomy formation at a mean age of 26 (24-46) days. Intra-operatively, small bowel perforation and adjacent pseudocysts filled with air and intestinal contents were noted in all 3 patients. Post-operatively full feeds were established in all patients.
  
  
  CONCLUSIONS
  In premature infants with NEC, intestinal perforation can be missed on occasions. Our patients interestingly, developed characteristic abdominal x-ray findings that in our experience should prompt for surgical intervention.
authors.affiliation: Department of Paediatric surgery, University Hospitals of Leicester Infirmary road, Leicester, United Kingdom LE1 5WW.
authors.forename: Sivasankar
authors.initials: S
authors.lastname: Jayakumar
authors.affiliation: Department of Paediatric surgery, University Hospitals of Leicester Infirmary road, Leicester, United Kingdom LE1 5WW.
authors.forename: Nitin
authors.initials: N
authors.lastname: Patwardhan
keywords: Missed intestinal perforation; Necrotizing enterocolitis; Neonate; Preterm; Pseudocyst