Pneumoperitoneum in infants without gastrointestinal perforation

Pneumoperitoneum signals gastrointestinal perforation and, as a rule, requires prompt laparotomy. However, we have recently encountered infants with severe respiratory distress who developed pneumoperitoneum without any gastrointestinal leak. These 10 patients were managed without operations. Three patients survived the respiratory distress and subsequently manifested no gastrointestinal disturbances. Five patients who died of pulmonary disease after conservative management of pneumoperitoneum had autopsies that revealed no gastrointestinal disease. We found no clinical or radiographic signs of peritonitis in these patients. Paracentesis and gastrointestinal x-rays revealed no gastrointestinal perforation. These critically ill newborns were thereby spared an unnecessary laparotomy. This experience confirms previous reports in the literature that, by clinical and radiographic correlations, "medical" pneumoperitoneum can often by distinguished from "surgical" pneumoperitoneum in critically ill infants with respiratory distress who may not easily tolerate an unnecessary laparotomy.