Pneumoperitoneum Associated with Pneumatosis Intestinalis in a Pediatric Patient

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.