An infant with intestinal pneumatosis and pneumoperitoneum: the difficult decision not to intervene

Abstract

Pneumoperitoneum in children may be due to causes that do not require urgent surgery (cardiopulmonary resuscitation manoeuvres, severe respiratory pathology or mechanical ventilation). Surgery in these cases could even worsen the prognosis. We present the case of a male infant, ex-preterm, with a history of necrotizing enterocolitis and ileal perforation at birth, requiring laparotomy and intestinal resection on two occasions and developing a secondary microcolon, due to disuse. At six months, after transitioning to full oral feeding, he presented abdominal distension with extensive intestinal pneumatosis and pneumoperitoneum on radiographs. His general appearance was good with normal intestinal transit and no peritonitis. The patient remained fasting with intravenous antibiotics, nasogastric decompression and parenteral nutrition. The evolution was favourable with oral feeding restarting on the seventh day of admission. The existence of pneumoperitoneum does not always require a laparotomy and global assessment of the patient by an interdisciplinary health team may avoid unnecessary aggressive treatments.

Tension pneumoperitoneum caused by rupture of intraabdominal soft tissue emphysema in a child supported with high-frequency oscillatory ventilation: a case report

“…There is a dilemma in the treatment of patients with spontaneous pneumoperitoneum. Many reported cases could be safely treated with non-surgical treatment by an awareness of this condition [7, 16, 17]. Our patient possessed some risks factors of non-surgical pneumoperitoneum, including infant period, ARDS with ventilatory support, and signs of barotrauma, for example, pneumothorax, pneumomediastinum, and subcutaneous emphysema.…”