Published online May 28, 2015. doi: 10.3748/wjg.v21.i20.6417
Peer-review started: November 3, 2014
First decision: December 26, 2014
Revised: January 24, 2015
Accepted: February 11, 2015
Article in press: February 11, 2015
Published online: May 28, 2015
Neonatal pneumoperitoneum is a surgical emergency indicative of gastrointestinal perforation that requires immediate treatment to prevent death. There have been non-surgical conditions secondary to neonatal pneumoperitoneum (e.g., mechanical ventilation, pulmonary diseases and pneumatosis cystoides intestinalis) that neonates were able to overcome without the need for abdominal exploration. Idiopathic pneumoperitoneum, although similar to perforation of the alimentary tract and the previously mentioned non-surgical conditions, is a more rare and benign condition that does not yet have a definite cause. Hence, inexperienced surgeons may have a difficult time providing the right treatment for idiopathic pneumoperitoneum. We report a case of a neonate with a massive pneumoperitoneum who obtained a favorable outcome without surgical intervention. Nonetheless, the cause of pneumoperitoneum remains unclear. We hypothesize that the right sized perforation (range: 2 mm to 4 mm in diameter) at the anterior wall of the stomach is needed for pneumoperitoneum to occur. As the baby cries (aerophagia), the air in the stomach accumulates until it can enter the intraperitoneal cavity through the leak compressed by gastric peristalsis, hence forming a large pneumoperitoneum. Small amounts of gastric juice are able to penetrate the gastric wall; therefore, no signs or symptoms of peritonitis occur. The gastric leak self-seals, preventing further passage of the air, allowing the intraperitoneal free gas to dissipate gradually. This case demonstrated that laparotomy can be avoided in neonates with idiopathic pneumoperitoneum if a timely diagnosis is established.
Core tip: Neonatal pneumoperitoneum is often deemed an emergency requiring prompt abdominal exploration to increase the chance of survival. Supporting therapy management has been successful in treating idiopathic neonatal pneumoperitoneum with excellent outcomes. This report describes a rare case of idiopathic neonatal pneumoperitoneum without a definite cause. A favorable prognosis was achieved without laparotomy. Therefore, a conservative treatment is feasible if prompt diagnosis is ascertained.