We read with interest the article of Farrugia and colleagues¹ about neonatal gastrointestinal perforation. However, there was no mention of:

• Isolated gastric perforation as a cause of neonatal gut perforation, or

• Transillumination as a simple diagnostic tool of pneumoperitoneum.

We highlight these two points relating to a recent case. A 29 week gestation baby girl was born by vaginal delivery. She initially required conventional ventilation for her lung disease. An umbilical arterial catheter was inserted but removed after a few hours due to duskiness of the toes. On day 2 she was extubated and nCPAP was tried. After a few hours, her condition deteriorated and she returned to conventional ventilation. On day 4, she was started on enteral feeding, using small volumes of breast milk, but had mild abdominal distension and some aspirates. Feeding was stopped. Her abdomen deteriorated and she had persistent metabolic acidosis. Transillumination of her abdomen was positive (fig 1) for pneumoperitoneum and was confirmed by abdominal x ray examination (fig 2). At laparotomy, two small gastric perforations were identified with local areas of infarction. These were oversewn, with excellent results.

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Figure 1

 Transillumination of the abdomen showing pneumoperitoneum.

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Figure 2

 Abdominal radiograph confirming pneumoperitoneum.

Neonatal gastric perforation is unusual but serious. Various causative factors, including prematurity and nCPAP, have been suggested.² Both of these were present in our case. It is also possible that emboli from the umbilical catheter led to small areas of infarction of the stomach wall.

Transillumination is a quick and easy technique for diagnosing pneumoperitoneum,³ and obviates the need for frequent radiographs.