Nous rapportons 2 cas de perforation colique néonatale focale spontanée (PCFS). La 1^re enfant, née à 36 3/7 semaines d’aménorrhée (SA), avait présenté à 3 j de vie un ballonnement abdominal sans répercussion sur l’état général. Une lecture erronée de la radiographie de l’abdomen avait différé le diagnostic puis la laparotomie. L’évolution clinique avait été excellente, à court et à long termes. Le 2^ème enfant né à 38 5/7 SA, avait présenté à 2 j de vie un état septique avec des signes progressifs d’iléus. Une lecture erronée de la radiographie de l’abdomen avait également différé le diagnostic puis la laparotomie. L’évolution avait été compliquée à court terme mais bonne à long terme. Dans les 2 cas l’aspect radiologique, l’inspection de l’intestin à la laparotomie, les analyses histologiques et l’évolution à long terme avaient exclu une entérocolite ulcéronécrosante ou une maladie de Hirschsprung. Chez les nouveau-nés à terme ou proches du terme les PCFS sont rares. La littérature ne rapporte aucun facteur de risque. Le signe clinique le plus spécifique semble être le ballonnement abdominal. La présence d’un pneumopéritoine radiologique constitue le signe le plus sensible. Le diagnostic de présomption posé, l’intervention chirurgicale doit être réalisée rapidement. Dans ce cas le pronostic vital semble être bon. L’objectif de ce travail est de rendre les pédiatres attentifs aux PCFS chez des nouveau-nés sans facteur de risque. Dans les cas rapportés, l’errance diagnostique aurait pu être évitée si la PCFS néonatale en dehors de la grande prématurité – avec sa traduction radiologique – avait été connue au préalable.

Two cases of neonatal focal spontaneous colic perforations are reported. The 1st infant, born at 36 3/7 weeks gestational age, presented on day 3 with crying, abdominal distension, and liquid stools. Clinical examination showed a slightly irritable hypothermic (35.7°C) infant with a distended abdomen and few bowel sounds. Blood tests were normal apart from an elevated C-reactive protein level (59mg/l). The abdomen x-ray was erroneously considered normal. The infant’s condition remained stable for nearly 3 days. After reviewing the initial x-ray, pneumoperitoneum was suspected and confirmed by a cross-table lateral abdominal x-ray. The infant was started on antibiotics and operated. Macroscopically, the entire gut was normal apart from a focal sigmoid perforation, which was stitched. A transmural colic biopsy revealed focal vascular dilation but was negative for necrotising enterocolitis or Hirschsprung disease. The infant recovered quickly. She is now a healthy, normal 3-year-old. The 2nd infant, born at 38 5/7 weeks gestational age, presented between day 1 and 2 with clinical signs of infection associated with slowly progressive ileus. The chest and abdomen x-ray was mistakenly considered normal. Frank septicemia developed. After reviewing the initial x-ray, pneumoperitoneum was suspected and confirmed by a cross-table lateral abdominal x-ray. The infant was operated. Macroscopically, the small intestine was normal, the ascending and transverse colons were dilated, and the descending and sigmoid colons were narrow. Three cecal perforations were discovered and stitched. An ileostomy and multiple colic biopsies were also performed. The postoperative course was complicated by persistent septic ileus due to descending and sigmoid colon leaks, which led to colic resections with end-to-end anastomosis. Rectal aspiration biopsies were also performed. At 1 month of age, the infant was discharged from the hospital. The ileostomy was closed in two steps at 2 and 5 months of age. A normal sweat test excluded cystic fibrosis. All colic and rectal biopsies revealed nonspecific inflammatory signs and excluded necrotizing enterocolitis and Hirschsprung disease. Nonspecific irregular thinning of muscularis mucosae and muscularis propria were observed in the two resected colic segments. The boy is now a healthy 7-year-old. The incidence of neonatal focal spontaneous colic perforations at term or close to term is unknown but probably very rare. Our department is the neonatal referral center for approximately 14,000 annual births. In the last 10 years (2000–2009), out of 5115 neonatal admissions in our unit, only ten cases have presented a neonatal spontaneous intestinal perforation, seven of ten in very-low-birth-weight infants and three of ten in term or near-term neonates (one with Hirschsprung disease and the two cases reported herein). In the same period, 108 infants suffered from necrotizing enterocolitis, seven of 108 were term infants and 6 out of 7 had a congenital heart disease. The medical literature is poor on the subject of focal spontaneous colic perforations at term; no risk factor is described. The most specific clinical sign seems to be the abdominal distension. The presence of pneumoperitoneum on an abdominal x-ray is the most sensitive paraclinical sign. In case of an intestinal perforation, surgery must be performed quickly. The vital prognosis seems to be good. The objective of this study was to draw pediatricians’ attention to focal spontaneous colic perforations in term or close to term newborns. In the cases reported, the diagnostic delays could have been prevented if the entity – with its radiological manifestation – had been well known.