title: Idiopathic neonatal pneumoperitoneum with favorable outcome: A case report and review.
abstract: Neonatal pneumoperitoneum is a surgical emergency indicative of gastrointestinal perforation that requires immediate treatment to prevent death. There have been non-surgical conditions secondary to neonatal pneumoperitoneum (e.g., mechanical ventilation, pulmonary diseases and pneumatosis cystoides intestinalis) that neonates were able to overcome without the need for abdominal exploration. Idiopathic pneumoperitoneum, although similar to perforation of the alimentary tract and the previously mentioned non-surgical conditions, is a more rare and benign condition that does not yet have a definite cause. Hence, inexperienced surgeons may have a difficult time providing the right treatment for idiopathic pneumoperitoneum. We report a case of a neonate with a massive pneumoperitoneum who obtained a favorable outcome without surgical intervention. Nonetheless, the cause of pneumoperitoneum remains unclear. We hypothesize that the right sized perforation (range: 2 mm to 4 mm in diameter) at the anterior wall of the stomach is needed for pneumoperitoneum to occur. As the baby cries (aerophagia), the air in the stomach accumulates until it can enter the intraperitoneal cavity through the leak compressed by gastric peristalsis, hence forming a large pneumoperitoneum. Small amounts of gastric juice are able to penetrate the gastric wall; therefore, no signs or symptoms of peritonitis occur. The gastric leak self-seals, preventing further passage of the air, allowing the intraperitoneal free gas to dissipate gradually. This case demonstrated that laparotomy can be avoided in neonates with idiopathic pneumoperitoneum if a timely diagnosis is established.
authors.affiliation: Tao-Zhen He, Chang Xu, Yi Ji, Min Liu, Department of Pediatric Surgery, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China.
authors.forename: Tao-Zhen
authors.initials: TZ
authors.lastname: He
authors.affiliation: Tao-Zhen He, Chang Xu, Yi Ji, Min Liu, Department of Pediatric Surgery, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China.
authors.forename: Chang
authors.initials: C
authors.lastname: Xu
authors.affiliation: Tao-Zhen He, Chang Xu, Yi Ji, Min Liu, Department of Pediatric Surgery, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China.
authors.forename: Yi
authors.initials: Y
authors.lastname: Ji
authors.affiliation: Tao-Zhen He, Chang Xu, Yi Ji, Min Liu, Department of Pediatric Surgery, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China.
authors.forename: Xiao-Yan
authors.initials: XY
authors.lastname: Sun
authors.affiliation: Tao-Zhen He, Chang Xu, Yi Ji, Min Liu, Department of Pediatric Surgery, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China.
authors.forename: Min
authors.initials: M
authors.lastname: Liu
mesh_terms: D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D011027:Pneumoperitoneum / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D011237:Predictive Value of Tests; D012307:Risk Factors; D016896:Treatment Outcome
keywords: Intestinal perforation; Newborn; Pneumoperitoneum; Therapeutics