Isolated Multiple Perforations in the Descending Colon of a Term Baby Who Presented With Vomiting: A Case Report and Literature Review.

Neonatal intestinal perforation is a life-threatening surgical emergency that is more commonly described in preterm or low-birth-weight infants. Isolated descending colonic perforation in a term neonate is rare and may be difficult to recognize when symptoms are non-specific. We report a male newborn delivered at 37+2 weeks, weighing 2.6 kg, with Apgar scores of 9 and 9 at 1 and 5 minutes. Breastfeeding was started at two hours and was initially tolerated. At 12 hours, he developed poor feeding and brownish vomiting, while stool passage was present from day one. Initial laboratory tests and chest and abdominal X-ray findings were not diagnostic. He later developed persistent bilious nasogastric aspirate, rising inflammatory markers, thrombocytopenia, Escherichia coli bacteremia, and respiratory deterioration. A contrast study did not show malrotation or intestinal obstruction. In view of further clinical deterioration and abdominal distension, an abdominal X-ray was repeated and demonstrated pneumoperitoneum. Emergency laparotomy revealed fecal peritonitis and multiple isolated left descending colon perforations. Histopathology showed a necrotic, perforated descending colon and excluded Hirschsprung disease. After Hirschsprung disease, necrotizing enterocolitis, and intestinal obstruction were considered less likely, idiopathic colonic perforation was considered the most likely explanation. Later, severe sepsis may have aggravated the bowel injury rather than caused the initial perforation. This case emphasizes the importance of repeated clinical assessment and imaging, and early surgical reassessment in deteriorating neonates.