Bowel perforation in the newborn: diagnosis with metrizamide

Although the diagnosis of bowel perforation is frequently straightforward, it may be difficult in the neonate. Clinical signs may be limited to abdominal distension. If the patient is on assisted ventilation, pneumoperitoneum may be due to air tracking down from the chest rather than perforation. The authors report 6 cases of bowel perforation in infants in whom the diagnosis could not readily be made from the clinical findings and plain radiographs but was apparent when oral metrizamide was employed. This suggests that metrizamide can be a valuable adjunct in some cases of neonatal bowel perforation.