title: Clinical spectrum of neonates presenting with pneumoperitoneum: A retrospective study.
abstract: BACKGROUND
  Neonatal pneumoperitoneum is attributed, in most of the reported cases, to necrotising enterocolitis (NEC). There are also other causes leading to free intraperitoneal air. The aim of this study is to describe the clinical spectrum, causes, management and outcome of neonates admitted with pneumoperitoneum in the paediatric surgery unit of a university hospital.
  
  
  METHODS
  This retrospective study included neonates having radiographic evidences of pneumoperitoneum from 2012 to the end of 2014. Patients' files were analysed regarding age at admission, birth weight, history, clinical picture, management, operative findings and subsequent outcome.
  
  
  RESULTS
  Fifty-six out of 379 neonates (14.7%) were found to have pneumoperitoneum during the study period. There were 35 males (62.5%) and 21 females (37.5%). Cases diagnosed as NEC represented 27 neonates (48.2%). There were 29 cases (51.8%) with causes not related to NEC. Non-NEC causes were spontaneous intestinal perforation (8.9%), ano-rectal malformations (7.1%), Hirschsprung's disease (14.2%), ileal atresia (3.5%), incarcerated inguinal hernia (1.7%), gastric perforation (1.7%) and meconium ileus (1.7%). In seven patients (12.5%), those who were managed conservatively (8.9%) or whose laparotomy was negative (3.6%), no cause of pneumoperitoneum could be reached. Overall mortality was 25%, 78.5% of which was NEC-related.
  
  
  CONCLUSIONS
  Neonatal pneumoperitoneum is an alerting finding for paediatric surgeons. Most cases imply serious causes with a significant morbidity and mortality, NEC being the most common cause. On the other hand, pneumoperitoneum is not an absolute indication for surgery. Careful assessment and tailored management can limit the morbidity of unnecessary laparotomies.
authors: Department of Surgery, Paediatric Surgery Unit, Faculty of Medicine, Zagazig University Hospitals, Zagazig, Egypt.
authors: Ahmed Hosni
authors: AH
authors: Morsi
authors: Department of Paediatric Surgery, Benha Children Hospital, Banha, Kaliobeya, Egypt.
authors: Hossam Rashad
authors: HR
authors: Omar
authors: Department of Surgery, Paediatric Surgery Unit, Zagazig University Hospitals, Zagazig, Egypt.
authors: Ahmed
authors: A
authors: Osama
authors: Department of Paediatric Surgery, Benha Children Hospital, Banha, Kaliobeya, Egypt.
authors: Ahmed Refaat
authors: AR
authors: Khodary
mesh_terms: D005260:Female; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D011027:Pneumoperitoneum / Q000150:complications / Q000175:diagnosis* / Q000628:therapy*; D012189:Retrospective Studies