Introduction In spontaneous intestinal perforation (SIP), there is a focal perforation of the gut, with the rest of the bowel appearing normal. Associated factors include prematurity, postnatal steroids and indomethacin.

Cases Over 6 years we have encountered three cases of SIP, each occurring in a premature twin. Gestations were 26, 29+4 and 29+6 weeks. Two cases involved a male dichorionic diamniotic twin, the female was a monochorionic diamniotic twin with a diagnosis of twin to twin transfusion syndrome. Antenatally each mother received steroids. Following birth all three babies were intubated, ventilated and given surfactant. Two received trophic feeds of expressed breast milk prior to the diagnosis of SIP. The age at perforation varied between day 2 and day 5. Perforation sites were very similar. At the time of diagnosis all babies were relatively well. Two had been extubated onto CPAP, the other required minimal ventilation. No babies were receiving inotropic support. Full blood count, C reactive protein and blood gas were normal. All underwent bowel surgery and are currently well.

Conclusion Our experiences prompted us to investigate whether being a twin was a risk factor for SIP. Despite a detailed literature search we could find no evidence suggesting this. Interestingly, however, there are several reported incidences of SIP occurring in both twins, simultaneously at identical sites. Further research is warranted to investigate if being a twin is a risk factor for SIP.