neonatal intestinal perforation ( nip ) is an extremely rare complication of intestinal hemangioma ( ih ) .
neonates younger than 30 days and having perforation include more common etiologies such as necrotizing enterocolitis , meconium ileus , and spontaneous idiopathic as well as gastric perforation.1 nip has been associated with mortality rates of 40% to 70%.2 this report presents a rare case of nip resulting from ih .
a 27-day - old male neonate was admitted with low - grade fever , abdominal distension , and bilious vomiting associated with bouts of diarrhea of 2 days duration .
baby was a product of full - term spontaneous vaginal delivery with normal prenatal follow - up . before coming to our hospital ,
the patient weighed 4.1  kg and was febrile , irritable , and moderately dehydrated .
plain abdominal radiographs suggested bowel obstruction versus ileus , therefore a barium meal follow through was obtained , which showed persistently dilated jejunal and proximal ileal loops but normal flow of contrast .
computed tomographic scan with intravenous contrast was not done because of family history of allergic reaction to the dye . on the basis of the diagnosis of intestinal obstruction , a decision for exploratory laparotomy was made .
laparotomy revealed dense inflammatory adhesions surrounding a solitary hemangioma located at the antimesenteric border 30 cm from the ileocaecal valve and on close inspection a small perforation was seen on one side of the hemangioma , which was sealed by extensive adhesions ( fig .
other areas of the bowels inspected were normal and resection with primary anastomosis was done . 

dilated capillary spaces lined by single layer of endothelium with proliferation of endothelial cells in between .
hemangiomas of the gastrointestinal tract are rare and account for only 0.05% of all intestinal neoplasms.3 they are commonly found within the small bowel , jejunum being the commonest site and compose 7 to 10% of all benign tumors.3 

4 they have a tendency toward multiplicity , with solitary tumors being extremely rare.3 
 5 microscopically , ih may be classified as cavernous , capillary , or mixed types , commonest being the cavernous.6 the usual presentation is intestinal bleeding usually insidious presenting as anemia7 or sometimes acute and potentially life threatening.4 other forms of rare presentation include intussusception , obstruction , and perforation.8 
 9 
 10 
  ileal perforation is a rare complication of ih in neonates , and so far , only one case has been reported in the literature , by mcgaughey et al,11 who discovered evidence of ileal perforation due to ih while operating on a neonate with intestinal obstruction .
ours is the second reported case of nip due to ih , and what makes it unique is the fact that the hemangioma belonged to the rare capillary type whereas the previously reported case was of the commoner cavernous type .
diagnosis in both reported cases , including ours , were made only at surgery for presumed acute intestinal obstruction .
although various causes of nip including the rare ih have been reported , diagnosis can be difficult and exploratory laparotomy has often proved to be the final diagnostic tool .
although a rare cause of intestinal perforation in neonates , ih should be considered in the differential diagnosis .
 intestinal perforation is an extremely rare complication of hemangioma of the small intestine in the neonatal period . 
 this is a case report of a 27-days - old male infant who presented with signs and symptoms of acute intestinal obstruction . 
 exploratory laparotomy findings revealed intestinal perforation due to solitary hemangioma in the ileum , which led to obstruction from peritoneal reaction and adhesions . 
 there are two reported cases in the literature presenting with ileal perforation in the pediatric age group , but only one previous report mentioned in the neonatal period . because there are other more common causes of perforation in the neonatal period , intestinal hemangioma in spite of its rarity 
 should be included in the differential diagnosis . 