Inguinal hernias (see Acute Abdomen and Surgical Gastroenterology: Hernias of the Abdominal Wall) develop most often in male neonates, particularly if they are premature. About 10% of inguinal hernias are bilateral. Because inguinal hernias can become incarcerated, repair should be done shortly after diagnosis. For premature infants, repair typically is not done until they have reached a weight of 2 kg. In contrast, umbilical hernias rarely become incarcerated, close spontaneously after several years, and do not ordinarily need surgical repair.
In neonates, gastric perforations are often spontaneous and may be due to a congenital defect in the stomach wall, usually along the greater curvature. The abdomen suddenly becomes distended, and massive pneumoperitoneum is seen on abdominal x-ray. Treatment with corticosteroids increases risk of this disorder. Giving an H2 blocker raises the gastric pH in premature infants and may reduce risk by inhibiting HCl production. Prognosis is usually good after surgical repair of the perforation.
In premature infants, ileal perforation has been reported after indomethacin has been given to close a patent ductus arteriosis. Ileal perforation is probably related to local ischemia resulting from vasoconstriction caused by indomethacin.
Mesenteric arterial occlusion:
Mural thrombi or emboli may occlude a mesenteric artery after high placement of an umbilical artery catheter. Such an occurrence is extremely rare but can cause extensive intestinal infarction requiring surgery and intestinal resection.
Last full review/revision November 2007 by William J. Cochran, MD
Content last modified February 2012