Abdominal Plain Radiograph in Neonatal Intestinal Obstruction

Prasad, G Raghavendra; Aziz, Amtul

doi:10.21699/jns.v6i1.483

Cited by 11 publications

(14 citation statements)

References 6 publications

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“…triangular or a semilunar collection of air anterior to the abdominal viscera or above the liver in lateral decubitus position, (c) large volume of free air may give rise to the football sign, where the air outlines the whole of the peritoneal cavity and under the surface of the diaphragm, (d) the lacing of the football i.e. outlining of falciparum ligament of the liver against the radiolucency of free abdominal air on supine view [4,5,6] (e) Rigler sign or double-wall sign is free gas on both sides of the bowel wall, [4,5] (f) pneumoscrotum has been explained due to presence of patent processus vaginalis and passage of air from the peritoneal cavity into the scrotum. [3,5,6] The clinical findings in pneumoperitoneum secondary to NEC or neonatal GI perforation include features of peritonitis, tense abdominal distension, palpable, distended bowel loops, shiny red induration of abdominal wall, tenderness, muscle stiffness, guarding, shifting dullness, and absent (decreased) bowel sounds.…”

Section: Discussionmentioning

confidence: 99%

Spontaneous pneumoperitoneum: Discerning from radiological imaging

Gupta

2021

J Neonatal Surg

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Background: Pneumoperitoneum without any gastrointestinal (GI) perforation or peritonitis is entitled spontaneous pneumoperitoneum. We aimed to describe a radiological perspective in spontaneous pneumoperitoneum. Methods: This case series presented data of 4 cases of spontaneous pneumoperitoneum managed at our institution. Results: There were 85 patients with a provisional diagnosis of necrotizing enterocolitis (NEC) and/or pneumoperitoneum. Out of these, there were 4 patients with the final diagnosis of spontaneous pneumoperitoneum; three males and 1 female. At presentation, respiratory distress was seen in 3. It was preceded by mechanical ventilation in 3 patients. All 4 had soft abdominal distension, absence of features suggestive of peritonitis, and the presence of free air with an absence of air-fluid level in peritoneal cavity on erect abdominal radiographs. The Rigler sign was present in 3 patients. Abdominocentesis followed by abdominal drain placement was performed in 2 patients. Laparotomy was performed in 1 patient which could not point to any pathology (negative). An unfavorable outcome was seen in one patient with associated esophageal atresia. No patient had any evidence (either ultrasound/radiological or on laparotomy) of leakage of contents from the GI tract. Conclusions: In infants, especially preterm neonates, presenting with soft abdominal distension with abrupt onset of pneumoperitoneum, without clinical features of peritonitis and preceded by mechanical ventilation, diagnosis of spontaneous pneumoperitoneum should be considered.

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Section: Discussionmentioning

confidence: 99%

Spontaneous pneumoperitoneum: Discerning from radiological imaging

Gupta

2021

J Neonatal Surg

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“…The plain abdominal radiographic findings of dilated small bowel greatly supported a diagnosis of intestinal obstruction. However, the possibility of minute perforation couldn't be excluded since he presented with additional features of peritonitis (8,9).…”

Section: Discussionmentioning

confidence: 99%

“…A plain radiograph of abdomen continues to be a useful tool for the diagnosis of neonatal intestinal obstruction demonstrating distended bowel loop or double bubble in proximal obstruction secondary to duodenal atresia (8,9) The management of neonatal intestinal perforation depends on the aetiological factor and varies to include primary repair, resection and anastomoses, ileostomy, colostomy, gastrectomy and gastroduodenostomy (10)(11)(12). Though, Hiller et al reported neonates with ileal atresia who undergo primary resection and anastomosis had a better outcome than those who had secondary anastomosis, mortality and major complications are seen in neonates managed with primary anastomoses compared to ileostomy (13,14) Case description A four (4) day old neonate, born to a 21-year-old primiparous mother delivered at term with a birth weight of 2.30 kg was admitted as a referral from another health unit with failure to pass stool associated with abdominal distension, vomiting of non-bilious content and irritability since birth.…”

Section: Introductionmentioning

confidence: 99%

Neonatal small bowel perforation in ileal atresia in a low resource setting: A case report

Okidi¹,

Viola²,

Aber³

et al. 2020

Preprint

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Jejunoileal atresia is a common cause of neonatal intestinal obstruction with high mortality and morbidity in a low resource setting where surgical care is lacking. Herein, a 4-day-old presented with features of acute abdomen and septicaemia, managed with ileostomy diversion and recovered uneventfully. Back ground Neonatal surgical care and neonatal intensive care is lacking in Uganda while jejunoileal atresia and stenosis are still the most common causes of neonatal intestinal obstruction with high mortality and morbidity in a low resource setting. Herein, we presented a 4-day-old neonate who presented to the emergency department as a referral from distant peripheral hospital with features of acute abdomen and septicaemia. He was resuscitated and an ileostomy diversion created. He recovered uneventfully from the hospital and discharged. However, he passed on upon readmission six weeks later from severe acute malnutrition. Conclusion A high index of suspicious on concomitant intestinal perforation in a neonate presenting with intestinal obstruction and delayed access to surgical care while approaches such as intestinal diversion should be sought carefully to mitigate serious consequences of anastomotic leak from primary bowel repair.

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“…The index case demonstrated the classical soap bubble pattern of gas distribution seen in necrotising enterocolitis. The differential diagnoses of this soap bubble appearance in abdominal radiographs of a neonate are pneumatosis intestinalis (as part of necrotising enterocolitis) due to intramural bowel gas and meconium plug syndrome due to the air captured between the meconium pellets 3. Pneumatosis intestinalis is a pathognomonic radiological sign of necrotising enterocolitis.…”

Section: Descriptionmentioning

confidence: 99%