Do pneumoperitoneum in a stable extreme low-birth-weight infant always need laparotomy? A clinical conundrum

Abstract

A premature female neonate born at 27 weeks of gestational age with a birth weight of 1000 g, developed spontaneous pneumoperitoneum on day 10 of life. The baby remained clinically stable with constant serial blood gases and inflammatory markers. In view of clinical stability, she was managed conservatively with parenteral nutrition and intravenous antibiotics and monitored closely for any clinical deterioration. After 7 days of conservative management, serial radiological images showed complete resolution of pneumoperitoneum. This case challenges the default notion of presumed necrotizing enterocolitis/spontaneous intestinal perforation and urgent laparotomy in an extreme preterm baby with pneumoperitoneum. Successful conservative management of this case also demands a question whether all pneumoperitoneum should be subjected to laparotomy.

Keywords

• idiopathic pneumoperitoneum
• necrotizing enterocolitis
• nonsurgical pneumoperitoneum
• spontaneous intestinal perforation