Tapping for pneumoperitoneum in neonates and infants

Abstract

Purpose The aim of this study was to shed some light on the presence of pneumoperitoneum in neonates and infants and to present and evaluate our method for its treatment.
Materials and methods This study included 33 patients diagnosed with pneumoperitoneum during 2004–2011, of whom 19 were girls and 14 were boys, and their ages ranged from 1 week to 5 months; 21 patients were neonates and seven of them were premature; two were aged less than 32 weeks and had mild pneumoperitoneum, which could be treated conservatively and five were aged between 32 and 34 weeks. Tapping was performed for all patients. Tapping can help in selection of patients with necrotizing enterocolitis needing exploration when the aspirate is bilious or feculent. Tapping could be performed as a temporary measure before exploration to decrease respiratory distress and the occurrence of abdominal compartment syndrome and also as a routine procedure in patients with pneumoperitoneum. Tapping is an easy procedure and can be performed with the patient in bed or in the incubator. Pneumoperitoneum is not an absolute indication for surgical exploration and a small subset of patients should be managed by laparotomy. Each patient with pneumoperitoneum should be assessed and categorized for tapping, placement of a tube drain, or surgical exploration. Pneumoperitoneum occurs in neonates more frequently than in infants, and most cases are idiopathic.
Results A total of 29 patients were treated by tapping alone (in nine patients, tapping was performed once; in 13, it was performed twice, and in the other seven, it was performed three to four times). Rapid improvement in the general condition and respiratory distress occurred in most patients. Six patients (five neonates and one infant) were explored because of: (a) aspiration of a bile-stained or feculent fluid in two patients and (b) failure of conservative treatment in four patients.
Conclusion Pneumoperitoneum occurs in neonates more than infants and most cases are idiopathic. Each case of pneumoperitoneum should be assessed and categorized for tapping, placement of a tube drain or surgical exploration. Pneumoperitoneum is not an absolute indication for surgical exploration and small subset of patients should be managed by laparotomy. Tapping is an easy job and can be done with the patient in bed or in the incubator. Tapping could be performed as a routine in cases of pneumoperitoneum. Tapping could be done as a temporary measure before exploration to decrease respiratory distress and abdominal compartment syndrome.