[Massive pneumoperitoneum in a newborn with mechanical ventilation in apparent absence of barotrauma]

Pneumoperitoneum is usually secondary to perforation of gastrointestinal tract. Sometimes it is a barotrauma, especially in newborn infants undergoing mechanical ventilation, causing lung rupture and passage of air from airway into the peritoneum through the mediastinum. It seems less likely that the pneumoperitoneum occurs in a patient undergoing mechanical ventilation, in the absence of a demonstrable barotrauma and a bowel perforation. We present a preterm patient who, on her third day of life, while being subjected to mechanical ventilation, reports a massive pneumoperitoneum with the apparent absence of barotrauma. After the drainage of the peritoneal cavity, the pneumoperitoneum disappears in two days, without laparotomy. The subsequent evolution is favourable.