title: Diagnosis and treatment of pediatric benign pneumoperitoneum: A case report series of 9 patients.
abstract: BACKGROUND
  Benign pneumoperitoneum (BPPT) is defined as asymptomatic free intraabdominal air or as pneumoperitoneum without peritonitis. Symptomatic free air requires surgical anagement, but management of asymptomatic pneumoperitoneum is controversial. In this study, we investigate the diagnosis and treatment of BPPT in children.
  
  
  RESULTS
  The clinical data of 9 pediatric patients with BPPT who were admitted to our hospital from January 2000 to January 2015 were retrospectively analyzed to summarize the diagnosis and treatment. Overall, 9 cases were included with 8 males and 1 female, aged from 4 days to 4 years. Among them there were 6 newborns (including 1 premature infant). Patients were all admitted to hospital with the major clinical symptom of abdominal distension, including 2 cases accompanied by tachypnea, 2 cases with vomiting, 1 case with diarrhea, and 2 cases with fever. No previous constipation or obstructive defecation existed. Six newborns had meconium defecation within 24 hours after birth. Physical examination revealed all patients with relaxed abdominal wall except 1 patient with abdominal distension had slight muscle stiffness and hyperactive bowel sounds. Abdominal X-ray suggested free air under the diaphragm in all cases.
  
  
  RESULTS
  All patients except for one case of laparotomy were conservatively treated and cured with fasting, infection prevention, rehydration, abdominocentesis, and close observation. Nine cases of patients were all discharged with no death occurrence. After discharge follow-up of 7 months to 6 years was conducted. There was no recurrence of similar symptoms, and children were in good growth and development.
  
  
  CONCLUSIONS
  The diagnosis of BPPT mainly relies on clinical symptoms in patient, careful abdominal examination, abdominal X-ray combined with abdominocentesis, and the exclusion of gastrointestinal perforation for confirmation. Conservative treatment can cure the disease. Attention should be paid to distinguish with surgical pneumoperitoneum to avoid unnecessary surgical exploration.
authors.affiliation: aDepartment of Pediatric Surgery, The Second Affiliated Hospital of Shantou University Medical College bDepartment of Radiology, The First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China.
authors.forename: Shou-Xing
authors.initials: SX
authors.lastname: Duan
authors.forename: Zong-Bo
authors.initials: ZB
authors.lastname: Sun
authors.forename: Guang-Huan
authors.initials: GH
authors.lastname: Wang
authors.forename: Jun
authors.initials: J
authors.lastname: Zhong
authors.forename: Wen-Hui
authors.initials: WH
authors.lastname: Ou
authors.forename: Ma-Xian
authors.initials: MX
authors.lastname: Fu
authors.forename: Fu-Sheng
authors.initials: FS
authors.lastname: Wang
authors.forename: Shu-Hua
authors.initials: SH
authors.lastname: Ma
authors.forename: Jian-Hong
authors.initials: JH
authors.lastname: Li
mesh_terms: D002675:Child, Preschool; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007813:Laparotomy; D008297:Male; D010808:Physical Examination; D011027:Pneumoperitoneum / Q000000981:diagnostic imaging* / Q000209:etiology / Q000628:therapy*; D011860:Radiography, Abdominal; D012189:Retrospective Studies; D016896:Treatment Outcome