PNEUMOPERITONEUM IN INFANTS WITHOUT GASTROINTESTINAL PERFORATION

Abstract

Pneumoperitoneum signals gastrointestinal perforation and, as a rule, requires prompt laparotomy. Infants with severe respiratory distress who developed pneumoperitoneum without any gastrointestinal leak were recently encountered. These 10 patients were managed without operations. Three patients survived the respiratory distress and subsequently manifested no gastrointestinal disturbances. Five patients who died of pulmonary disease after conservative management of pneumoperitoneum had autopsies that revealed no gastrointestinal disease. No clinical or radiographic signs of peritonitis were found in these patients. Paracentesis and gastrointestinal X-rays revealed no gastrointestinal perforation. These critically ill newborns were thereby spared an unnecessary laparotomy. By clinical and radiographic correlations, medical pneumoperitoneum can often be distinguished from surgical pneumoperitoneum in critically ill infants with respiratory distress who may not easily tolerate an unnecessary laparotomy.