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Not All Pneumoperitoneum Needs a Knife.

Anilkumar Pura Lingegowda1, R Sushmitha1

  • 1Department of Pediatric Surgery, Sakra World Hospital, Bengaluru, Karnataka, India.

Journal of Indian Association of Pediatric Surgeons
|August 4, 2025
PubMed
Summary
This summary is machine-generated.

Pneumoperitoneum, or free air in the abdomen, can rarely stem from thoracic air leaks like pneumothorax. This case highlights conservative management for such cases, avoiding unnecessary surgery.

Keywords:
Neonatal surgerynonoperative managementpneumothoraxspontaneous pneumoperitoneum

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Area of Science:

  • Pediatric Surgery
  • Thoracic Surgery
  • Gastroenterology

Background:

  • Pneumoperitoneum typically indicates hollow viscus perforation requiring surgery.
  • Thoracic air leaks, such as pneumothorax, can uncommonly cause pneumoperitoneum.
  • Conservative management is possible for pneumoperitoneum secondary to pneumothorax if diaphragmatic splinting is absent.

Observation:

  • A 1-month-old infant with respiratory distress developed pneumoperitoneum after intubation.
  • Imaging revealed bilateral pneumothorax and pneumoperitoneum.
  • Exploratory laparotomy showed no visceral perforation but confirmed free air originating from the thorax.

Findings:

  • The infant was successfully managed nonoperatively with bilateral intercostal drains.
  • The pneumoperitoneum resolved, and the infant was discharged after 7 days.
  • This case underscores pneumoperitoneum secondary to pneumothorax as a differential diagnosis.

Implications:

  • Recognizing this rare condition can prevent unnecessary surgical interventions and associated morbidity.
  • Clinical clues include absence of GI symptoms, history of respiratory distress, and extraperitoneal air on imaging.
  • Emphasizes the importance of considering thoracic causes for abdominal air in neonates.