Neonatal pneumoperitoneum: a critical appraisal of its causes and subsequent management from a developing country

Abstract

Neonatal pneumoperitoneum remains a surgical emergency and outcome can be lethal if the problem is not addressed early. NEC remains the major cause; however, there are several other important causes of isolated gastrointestinal perforations leading to neonatal pneumoperitoneum. The management should be individualized in these patients and the outcome largely depends on the early recognition of the condition.

Spontaneous perforation of the colon and rectum complicating anorectal malformations in neonates

“…Such muscular deficiency along with raised intraluminal pressure is probably responsible for more frequent rupture of the rectum in ARM. A high incidence of bowel perforation in CPC [4,18] also favors the muscular deficiency theory. In a subset of ARM cases, restored transmural perfusion after relief of obstruction appears to precipitate an ischemia-reperfusion injury and perforation somewhat analogous to the pathogenesis of necrotizing enterocolitis.…”

“…Colon perforation accounts for 15% of pneumoperitoneum seen in neonatal age group [4]. Bowel perforation increases the neonatal mortality of ARM from 3% to 23% [4,5]. Literature on this topic is restricted to anecdotal information and isolated case reports [6][7][8][9][10][11][12][13][14][15][16].…”

“…Colon perforation accounts for 15% of pneumoperitoneum seen in neonatal age group [4]. Bowel perforation increases the neonatal mortality of ARM from 3% to 23% [4,5].…”

Neonatal colonic perforation

“…Prolonged rupture of the membranes, maternal infections, fetal distress, lower APGAR score, recurrent apneic episodes, hypotension, presence of intraumbilical vascular catheter, exchange transfusion, and PDA are some of the conditions leading to low-flow states and hypoxia. In full-term infants, NEC is seen considerably at an earlier stage, which is thought to be related to prematurely initiated formula feeding (2,4,5,(7)(8)(9)(10)(11)(12)(13)(14). As well as in our patient, a history of birth asphyxia secondary to prolonged labor and enteral feeding was elicited.…”

Can Neonatal Pneumoperitoneum be Managed by Conservative Management Alone?

“…Spontaneous intestinal perforation like NEC is most commonly seen in premature low birth weight infants, but is unrelated to feeding and occurs in an earlier post natal age 1,3 .…”