A case of spontaneous intestinal perforation associated with candidiasis in a premature infant

Abstract

Intestinal perforation is a potentially life-threatening complication of pre-term birth. Focal or spontaneous intestinal perforation (SIP) is a type of intestinal perforation occurring in extreme prematurity which is less common than, and is reported to demonstrate some clinically and histologically distinct features from, necrotising enterocolitis (NEC). This case report describes a case of SIP of the small bowel associated with candidiasis in an extremely premature infant girl. Histologically, the bowel wall lacked the extensive coagulative necrosis typically seen in NEC; rather, the adjacent bowel showed some possible attenuation of the muscularis propria and a serosal fibrinoinflammatory exudate, with the mucosa and remainder of the bowel wall otherwise well preserved. Fungal spores and scattered pseudpohyphael elements within the serosal exudate and, very focally, within the outer half of the muscularis propria were only identified histologically after performance of special stains on the resection specimen. An association between SIP and candidial sepsis has previously been reported in the literature and this case highlights that identification of such cases can be aided by performing special stains on cases with clinical and/or histological features in keeping with SIP.