Gummalla Prabhavathi, Mundakel Gratias, Agaronov Maksim, Lee Haesoon
Department of Pediatrics, SUNY Downstate Medical Center and Kings County Hospital Center, 450 Clarkson Avenue, Brooklyn, NY 11203, USA.
Department of Pathology, Kings County Hospital Center, Brooklyn, NY, USA.
Case Rep Pediatr. 2017;2017:6907329. doi: 10.1155/2017/6907329. Epub 2017 Apr 16.
Pneumoperitoneum in a preterm neonate usually indicates perforation of the intestine and is considered a surgical emergency. However, there are cases of pneumoperitoneum with no evidence of rupture of the intestine reported in the literature. We report a case of pneumoperitoneum with no intestinal perforation in a preterm neonate with respiratory distress syndrome who was on high frequency oscillatory ventilation (HFOV). He developed bilateral pulmonary interstitial emphysema with localized cystic lesion, likely localized pulmonary interstitial emphysema, and recurrent pneumothoraces. He was treated with dexamethasone to wean from the ventilator. Pneumoperitoneum developed in association with left sided pneumothorax following mechanical ventilation and cardiopulmonary resuscitation. Pneumoperitoneum resolved after the pneumothorax was resolved with chest tube drainage. He died from acute cardiorespiratory failure. At autopsy, there was no evidence of intestinal perforation. This case highlights the fact that pneumoperitoneum can develop secondary to pneumothorax and does not always indicate intestinal perforation or require exploratory laparotomy.
早产儿气腹通常提示肠道穿孔，被视为外科急症。然而，文献中报道了一些无肠道破裂证据的气腹病例。我们报告一例患有呼吸窘迫综合征的早产儿，在接受高频振荡通气（HFOV）时出现无肠道穿孔的气腹。他出现双侧肺间质肺气肿并伴有局部囊性病变，可能为局限性肺间质肺气肿，且反复发生气胸。给予地塞米松治疗以撤机。在机械通气和心肺复苏后，气腹与左侧气胸相关联出现。胸腔闭式引流使气胸缓解后，气腹也随之消失。他死于急性心肺衰竭。尸检时，未发现肠道穿孔的证据。该病例突出了一个事实，即气腹可继发于气胸，并不总是提示肠道穿孔或需要进行剖腹探查。
