THE term 'spontaneous rupture' is accepted by the majority of authors to define perforation which occurs in an apparently normal bowel without any obvious cause. Several writers, however, include under this expression perforation occurring in association with other pathological conditions. Woodruff (1952), for example, reported 14 cases of perforation due to diverticulitis or carcinoma, and Levin and Isaacson (1960) stated that in I of their cases the histological examination showed fungal infection at the site of perforation.I t would seem preferable to distinguish spontaneous rupture associated with an obvious pathological lesion from that occurring in the absence of any recognizable cause, not only in order to avoid confusion but also because the management differs in each of these two groups. In the latter the term ' spontaneous ', as Cronin (1959) says, " has often been thought to be synonymous with idiopathic". Thus, it would seem not unreasonable to reserve the expression 'idiopathic rupture ' for those cases without other demonstrable local pathology and to use the term 'spontaneous rupture' for those in which some other lesion is found.T h e mechanism of rupture in a normal bowel and the aetiological factors implicated have been the subject of much discussion by different authors. Although several theories have been suggested, the precise mechanism of rupture is not yet well known and in some reported cases there is no satisfactory explanation.The purpose of this paper is to present 2 cases of such perforations and to discuss the condition with particular reference to its aetiology. Attention is also drawn to a new suggestion regarding the possible mechanism in a small number of cases. CASE REPORTSCase I.-L. B., a woman aged 75 years, was admitted to hospital on Sept. 16, 1961, as an abdominal emergency. She was complaining of severe lower abdominal pain of about 7 hours' duration. The onset was sudden, without any muscular effort or other violence, and without apparent cause. Gradually the pain became worse and spread all over the abdomen. There was no vomiting. Before the pain began she had two normal, soft motions. The patient gave a past history of intermittent diarrhoea and slight dyspepsia of 5 months' duration. She had had a right oophorectomy 35 years previously, and had subsequently given birth to a child.her temperature was 98" F., pulse-rate IOO per minute, and respiratory rate 30 per minute. Her blood-pressure was 130/7o. The tongue was furred, the abdomen not distended, but there was diffuse tenderness and rigidity, throughout. Bowel-sounds were present. Rectal examination revealed tenderness in the pouch of Douglas with a few scybalous faxes. There was no hernia. The clinical picture was suggestive of peritonitis and laparotomy was performed.AT OPERATION.-The abdomen was opened through a lower midline incision. Thin, purulent fluid and a ON EXAMINATION.-The patient looked acutely ill; considerable quantity of formed fzces were found in the peritoneal cavity. After these had been removed, a ...

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INTUSSUSCEPTION in Henoch-Schonlein purpura is of interest because of its rarity and the importance of making what may be a difficult diagnosis. We now report 2 cases in boys operated on during the acute phase, I requiring resection. CASE REPORTSCase I.-A. L., a boy of 4, was transferred from the Forest Hospital for Infectious Diseases as an abdominal emergency. He had been treated there for a week for a coryza with earache, intermittent lower abdominal pain, and latterly for 3 days loose yellow stools flecked with blood. The diarrhoea had abated the day before admission, but then recurred, with blood, more severe colicky abdominal pains, and occasional vomiting of bile.ON ADMISSION the child was pale and weak. The temperature was normal, but the pulse IOO per min. There was slight bleeding from the nose, and a slight purpuric rash on the abdomen and buttocks. The tonsils were congested. There was slight tenderness and probably a soft mass in the right side of the abdomen. There was a small right hydrocoele.INVESTIGATIONS included a normal midstream specimen of urine, a normal plain radiograph of the abdomen, and a normal blood examination, the details of which were as follows: haemoglobin, 12.3 g. per IOO ml. (83 per cent); total thrombocyte count, 480,000 per ml.; total leucocyte count, 15,100 per ml.; differential leucocyte count: A barium-enema examination was considered but it was decided that laparotomy was the most satisfactory course. At operation there was some clear free fluid in the peritoneal cavity. An ileocolic intussusception was discovered, the apex of which reached beyond the right third of the transverse colon. This was reduced manually and found to be due to haemorrhagic extravasation in the wall of the caecum. Several segments of ileum were scarlet with normal bowel between.Immediate postoperative recovery of the patient was uneventful. The second day after operation his general condition was quite satisfactory and the rash faded. The * Present address : The University of Athens, Greece.next day he passed a large quantity of old blood per rectum. His temperature rose to 100' F. and he was given a course of penicillin V 125 mg. twice a day for 5 days. His further convalescence was then uneventful, except that a week after the operation he developed a fresh crop of purpuric spots over the ankles and buttocks. These faded after 2 days and had disappeared after a further 3 days. Examination of the blood for C-reactive protein was negative.He was well when seen in out-patients 3 months later.Case 2.-D. G., a boy of 2& years, was admitted to hospital because he had been 'off colour ' for the previous 10 days. Seven days before admission he had fallen and knocked his right leg. In the evening of that day a swelling had appeared on the right calf and over the right ankle.This had subsided in a matter of 24 hours. Five days before admission there had been swelling of the scrotum which had subsided after 48 hours following the application of a lead-lotion compress. Four days before admission he had had ...