Case Report

We report a case of extremely preterm neonate 24 weeks, who presented with abrupt deterioration of her clinical condition with abdominal distension associated with bluish discoloration of her anterior abdominal wall due to sudden onset pneumoperitoneum. In view of worsening distension and compromise of her ventilation support ventilation, peritoneal drain was inserted initially that revealed serous peritoneal fluid with air bubble. Later on exploratory laparotomy confirmed normal bowel wall integrity. Concomitant chest x ray showed pulmonary interstitial emphysema. To our knowledge this is the 1st reported case of pneumoperitoneum 2ry to pulmonary air leak in 24 week extremely preterm neonate found to be associated with pulmonary interstitial emphysema with good survival and outcome.

Keywords: Pneumoperitoneum; Preterm Neonate, Pulmonary interstitial emphysema, pulmonary air leak syndromes

1. Karaman A., et al. “Does pneumoperitoneum always require laparotomy? Report of six cases and review of the literature”. Pediatric Surgery International 21 (2005): 819-824.
2. A bdelmohsen SM and Osman MA. “Idiopathic neonatal pneumoperitoneum, a case report”. International Journal of Surgery Case Reports 31 (2017): 250-253.
3. Wang CH., et al. “Neonatal pneumoperitoneum without certain aetiology”. Hong Kong Journal of Paediatrics 18 (2013): 268-269.
4. Leonidas JC., et al. “Pneumoperitoneum in ventilated newborns: a medical or a surgical problem?” The American Journal of Diseases of Children 128 (1974): 677-680.
5. Zerella JT and McCullough JY. “Pneumoperitoneum in infants without gastrointestinal perforation”. Surgery 89 (1981): 163-167.
6. Gupta R., et al. “Pneumoperitoneum in the newborn: is surgical intervention always indicated?” Journal of Neonatal Surgery 3 (2014): 32.
7. A l-Lawama M., et al. “Benign pneumoperitoneum in newborns: which abdomen to open and which one to observe?” Clinical Case Reports 4 (2016): 561-563.
8. Sammut A., et al. “Pneumoperitoneum in a neonate weighing less than 500 g. What do we really know about it?” Case Reports (2018): bcr-2018-224398.
9. Korones S. “Complications”. In: Goldsmith J, Karotkin E, eds. Assisted Ventilation of the Neonate. 5^th Philadelphia, PA: Saunders Elsevier (2011): 407-414.
10. He TZ., et al. “Idiopathic neonatal pneumoperitoneum with favorable outcome: a case report and review”. World Journal of Gastroenterology 21 (2015): 6417-6421.