• gastrointestinal perforation
• gut

Neonatal gastrointestinal perforation is a common condition carrying a mortality of 17–60%.¹ Clinical suspicion is supported by radiological signs, which may be subtle and must be sought specifically. We review these signs in the light of several recent instances of delayed recognition of intestinal perforations, one of which is described here.

A 24 day old preterm infant was referred to our centre for ligation of a patent ductus arteriosus after failed indomethacin treatment. The infant developed abdominal distension and bilious aspirates the following day. The abdominal radiograph at this stage was deemed “unremarkable”.

In view of clinical deterioration and persistent abdominal distension, a contrast study was performed. A small leakage of contrast into the right iliac fossa indicated a perforation. Review of previous radiographs from the referring centre (which had been temporarily mislaid) dislosed a classic football sign (fig 1): the central lucency had not …