An infant with intestinal pneumatosis and pneumoperitoneum: the difficult decision not to intervene
DOI:
https://doi.org/10.23938/ASSN.0293Keywords:
Pneumoperitoneum. Surgery. Infant. Interdisciplinary health team.Abstract
Pneumoperitoneum in children may be due to causes that do not require urgent surgery (cardiopulmonary resuscitation manoeuvres, severe respiratory pathology or mechanical ventilation). Surgery in these cases could even worsen the prognosis.
We present the case of a male infant, ex-preterm, with a history of necrotizing enterocolitis and ileal perforation at birth, requiring laparotomy and intestinal resection on two occasions and developing a secondary microcolon, due to disuse. At six months, after transitioning to full oral feeding, he presented abdominal distension with extensive intestinal pneumatosis and pneumoperitoneum on radiographs. His general appearance was good with normal intestinal transit and no peritonitis. The patient remained fasting with intravenous antibiotics, nasogastric decompression and parenteral nutrition. The evolution was favourable with oral feeding restarting on the seventh day of admission.
The existence of pneumoperitoneum does not always require a laparotomy and global assessment of the patient by an interdisciplinary health team may avoid unnecessary aggressive treatments.
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References
ANDIRAN F1, DAYI S, DILMEN U. Pneumoperitoneum: an absolute indication for surgery in infants with necrotizing enterocolitis?: Report of a case. Surg Today 2001; 31: 250-252.
PATEL RV, KUMAR H, PATWARDHAN N, ANTAO B. Pneumoperitoneum: a rare air leak in an infant with bronchiolitis and high-frequency oscillatory ventilation. BMJ Case Rep 2013; doi: 10.1136/bcr-2013-010447.
D'AGOSTINO S1, FABBRO MA, MUSI L, BOZZOLA L. Pneumatosis cystoides intestinalis: a rare cause of nonsurgical pneumoperitoneum in an infant. J Pediatr Surg 2000 Jul; 35: 1106-1108.
SANTOS NAHARRO J, AYUSO VELASCO R, BLESA SÁNCHEZ E. Neumoperitoneo masivo en un recién nacido con ventilación mecánica, en ausencia aparente de barotrauma. Cir Pediatr 2014; 27: 201-202.
KARAMAN A, DEMIRBILEK S, AKIN M, GÜRÜNLÜOĞLU K, IRŞI C. Does pneumoperitoneum always require laparotomy? Report of six cases and review of the literature. Pediatr Surg Int 2005; 21: 819-824.
KURBEGOV AC, SONDHEIMER JM. Pneumatosis intestinalis in non-neonatal pediatric patients. Pediatrics 2001; Aug 108: 402-406.
TALLANT C, TALLANT A, NIRGIOTIS J, MELLER J. Spontaneous pneumoperitoneum in pediatric patients: A case series. Int J Surg Case Rep 2016; 22: 55-58.
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