Abstract
Common causes of pneumoperitoneum in neonates includes necrotising enterocolitis (NEC), specific infections, gastro intestinal obstruction, iatrogenic causes, idiopathic focal intestinal perforation, perforation secondary to intra thoracic pathology, mechanical ventilation etc. Primary peritoneal drainage and exploratory laparotomy remain the definitive management of pneumoperitoneum in neonates. Here we report a case of suspected spontaneous idiopathic intestinal perforation managed conservatively with monitoring of vital signs. The neonate had an uneventful recovery. This case highlights the need to identify infants with benign or non surgical causes of pneumoperitoneum thus avoiding unnecessary laparotomies and referrals in these vulnerable neonates. DOI: http://dx.doi.org/10.3126/jnps.v32i3.5912 J. Nepal Paediatr. SocVol.32(3) 2012 252-253
Highlights
Primary peritoneal drainage and exploratory laparotomy remain the definitive management[1,2,3,4] of pneumoperitoneum in neonates
Spontaneous intestinal perforation like necrotising enterocolitis (NEC) is most commonly seen in premature low birth weight infants, but is unrelated to feeding and occurs in an earlier post natal age[1,3]
The mechanism best known as diving reflex results in Primary peritoneal drainage and exploratory laparotomy remain the definitive management of pneumoperitoneum.[1,2,3,4] the latter being preferred if the general condition permits
Summary
Primary peritoneal drainage and exploratory laparotomy remain the definitive management[1,2,3,4] of pneumoperitoneum in neonates. The antenatal period was uneventful; there was history of delayed cry following birth. The most dramatic picture was revealed in the straight X-RAY abdomen It revealed free gas under both the domes of diaphragm with downward and medial displacement of liver and spleen. Since the general condition of the patient was stable, a conservative management was decided upon with continuous monitoring of vital signs and provision of an exploratory laparotomy whenever wanted. Patient was put on conservative management with IVF and antibiotics with uneventful recovery, further strenghthening the diagnosis. A repeat skiagram on day 8 (D-8) of life showed considerable absorption of free gas. Baby was absolutely normal at follow up at the age of 1 month
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