Khan Ahmed, de Waal Koert
Neonatal Intensive Care Unit, John Hunter Children's Hospital, New Lambton, Newcastle, NSW 2305, Australia.
Case Rep Pediatr. 2012;2012:295657. doi: 10.1155/2012/295657. Epub 2012 Apr 3.
Pneumoperitoneum in the newborn is an acute surgical emergency requiring immediate surgical intervention to ensure survival. It refers to radiological evidence of rupture of an air-containing viscus with resultant soiling of the peritoneal cavity. A female baby was born preterm at 29 weeks with birth weight of 650 grams. She developed abdominal distension on day 6, and abdominal radiography revealed presence of free air in the peritoneum. She proceeded for a laparotomy, and intraoperative findings revealed blood in the peritoneum with an area of inflammation and a small perforation. About 5 cm of the inflamed bowel was resected, and an end to end anastomosis performed. The histopathology of the specimen was consistent with Meckel's diverticulum. Symptomatic Meckel's diverticulum is usually seen in the first two years of life, and perforation is a rare presentation. Perforated Meckel's diverticulum in a premature newborn is very rare, and a review of literature reveals only one other reported case. Newborn Meckel's perforation cases often mimic necrotizing enterocolitis, although many present without any feature of peritonitis. Establishing a preoperative diagnosis of perforated Meckel's is difficult and may not be essential as the treatment remains the same. However, prompt surgical intervention confers a good prognosis in neonates with isolated perforated Meckel's diverticulum.
新生儿气腹是一种急性外科急症，需要立即进行手术干预以确保存活。它指的是含气脏器破裂的影像学证据，导致腹腔污染。一名女婴在29周时早产，出生体重650克。她在出生后第6天出现腹胀，腹部X线检查显示腹膜内有游离气体。她接受了剖腹手术，术中发现腹膜内有血液，伴有炎症区域和一个小穿孔。切除了约5厘米发炎的肠段，并进行了端端吻合。标本的组织病理学与梅克尔憩室一致。有症状的梅克尔憩室通常在生命的头两年出现，穿孔是一种罕见的表现。早产新生儿的梅克尔憩室穿孔非常罕见，文献回顾仅发现另外一例报道病例。新生儿梅克尔憩室穿孔病例常类似坏死性小肠结肠炎，尽管许多病例没有任何腹膜炎特征。术前诊断梅克尔憩室穿孔很困难，而且由于治疗方法相同，可能也不必要。然而，对于孤立性梅克尔憩室穿孔的新生儿，及时的手术干预可带来良好的预后。
