Role of percutane peritoneal drainage in management of neonatal pneumoperitoneum: is surgery always necessary?

Abstract

Aims: The standard procedure in the management of neonatal pneumoperitoneum (NP) cases is laparotomy. However, in some of the cases in which surgery is not a viable option, percutaneous peritoneal drainage (PD) can be performed in order to stabilize the patient prior laparotomy. This study reviews the role of PD in NP patients using previous studies in the literature. Methods: 26 neonates diagnosed with NP in Van Yüzüncü Yıl Faculty of Medicine, Van Training and Research Hospital neonatal ICU from April 2015 to January 2018 were retrospectively reviewed. In terms of surgical assessment, patients were divided into 2 groups according to their birth weight. Group A consisted of neonates with birth weight above 1000 grams whereas Group B consisted of neonates with birth weight above 1000 grams whereas Group B consisted of neonates with a birth weight of 1000 grams or below. Demographic values, diagnosis, and treatment methods were put on record in patient files. Results: 10 cases (7 male – 3 female) in Group A had a mean body weight of 1850 (Range: 1070 – 3400 gr) grams. In this patient group, NP developed as a result of pneumothorax, necrotizing enterocolitis (NEC) and spontaneous intestinal perforation (SIP). 3 (30%) of the patients who were treated with classical approaches were lost during the treatment period. Group B consisted of 16 (9 male – 7 female) patients with a mean body weight of 780 (Range 470 – 950) grams. In this case group, NP developed as a result of NEC. PD was performed prior to conventional treatment procedures and 5 (31%) of the patients were lost during the treatment period. Conclusion: Group B had similar mortality rates with Group A. result explains to us that PD is a viable option in stabilizing the patient prior to laparotomy as a starting procedure, especially in neonates below 1000 grams and deemed as surgically unstable.