Case Report
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. May 28, 2015; 21(20): 6417-6421
Published online May 28, 2015. doi: 10.3748/wjg.v21.i20.6417
Idiopathic neonatal pneumoperitoneum with favorable outcome: A case report and review
Tao-Zhen He, Chang Xu, Yi Ji, Xiao-Yan Sun, Min Liu
Tao-Zhen He, Chang Xu, Yi Ji, Min Liu, Department of Pediatric Surgery, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
Xiao-Yan Sun, Health Management Centre, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
Author contributions: Xu C designed the research; Ji Y and Sun XY collected and analyzed the data; He TZ wrote the paper; and Liu M critically revised the paper.
Ethics approval: The study was reviewed and approved by the West China Hospital of Sichuan University Institutional Review Board.
Informed consent: All study participants or their legal guardian provided informed written consent prior to study enrollment.
Conflict-of-interest: The authors declare no conflict of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Min Liu, MD, Professor of Medicine, Department of Pediatric Surgery, West China Hospital of Sichuan University, No. 37 Guoxuexiang Road, Chengdu 610041, Sichuan Province, China.
Telephone: +86-28-85422888 Fax: +86-28-85422888
Received: November 1, 2014
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.

Keywords: Intestinal perforation, Pneumoperitoneum, Newborn, Therapeutics

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.