Jerliu Aulon, Harrison Lauren, Campbell Jacob
Department of Surgery, University of Connecticut School of Medicine, Farmington, Connecticut, USA. (Drs. Jerliu and Harrison).
Department of Pediatric Surgery, Connecticut Children's Medical Center, Hartford, Connecticut, USA. (Drs. Jerliu, Harrison, and Campbell).
CRSLS. 2025 Sep 15;12(3). doi: 10.4293/CRSLS.2025.00075. eCollection 2025 Jul-Sep.
Pneumoperitoneum in infancy raises concern for visceral perforation and resultant urgent surgical exploration. However, benign pneumoperitoneum-defined as free intraperitoneal air without gastrointestinal perforation-can occur rarely, especially in infants with chronic ventilatory dependence. We present an unusual case of an 8-month-old infant with severe bronchopulmonary dysplasia (BPD), tracheostomy, and gastrostomy-tube dependence, with radiographic evidence of pneumatosis intestinalis and free intraperitoneal air. Diagnostic laparoscopy was performed which identified air within the mesentery of the small and large intestine, without evidence of true pneumatosis, perforation, inflammation, or ischemia. The patient recovered from their surgery uneventfully without any complications. This case highlights the importance of recognizing benign pneumoperitoneum, particularly in medically complex ventilator-dependent pediatric patients, and emphasizes the role of diagnostic laparoscopy as a valuable tool to confirm bowel integrity, preventing unnecessary laparotomy.
婴儿气腹引发了对内脏穿孔及由此导致的紧急手术探查的担忧。然而，良性气腹（定义为无胃肠道穿孔的腹腔内游离气体）很少见，尤其是在有慢性通气依赖的婴儿中。我们报告了一例不同寻常的8个月大婴儿，患有严重支气管肺发育不良（BPD）、气管造口术和胃造瘘管依赖，影像学显示有肠壁积气和腹腔内游离气体。进行了诊断性腹腔镜检查，发现小肠和大肠系膜内有气体，但无真正的肠壁积气、穿孔、炎症或缺血迹象。患者术后顺利康复，无任何并发症。该病例凸显了认识良性气腹的重要性，尤其是在病情复杂的依赖呼吸机的儿科患者中，并强调了诊断性腹腔镜检查作为确认肠道完整性、避免不必要剖腹手术的宝贵工具的作用。
