Ahmad Hussain Mishwani.
Pneumoperitoneum in a Neonate.
Pak Armed Forces Med J Jan ;54(1):127-8.

A full term female baby of normal weight and appearance was delivered by elective caesarean section due to previous caesarean section of the mother. The baby developed tachypnoea immediately after birth, which was relieved by oxygen giveb by mask for a while. In a couple of hours she developed gross abdominal distension leading to respiratory distress and cyanosis. Abdomen was tense, tender and hyper resonant on percussion. Bowel sounds were absent. Rectum was normal and contained normal mecontium nasogastric tube passed to relieve abdominal distension, failed to aspirate the gastric content. XRay abdominal distension, confirmed gross pneumo-peritoneum-respiratory distress was relieved by urgent aspiration and decompression of peritoneal air by a needle passed in epigastrium. Ultrasound abdomen failed to reveal any free fluid in epigastrium. Ultrasound abdomen failed to reveal any free fluid in the peritoneal cavity due to large amount of gas, and was hence not helpful. To determine the exact cause and exclude the non surgical causes which can be treated without the major undertaking of a risk exploratory laparotomy in a poor risk neonate, Gastrograffin (water soluble contrast of choice study through nasogastric tube confirmed a large gastric perforation. Emergency laparotomy was performed. A 2cm large perforation was found high in the greater curvature of stomach. Peritoneal cavity was full of blood stained fluid. The gastric perforation was closed in layers after debridement of its necrotic edges, peritoneal toilet was done and abdomen closed in layers. The patient was discharged from the hospital on 7th post operative day after smooth removal, recovery and of stitches.

PakMediNet -Pakistan's largest Database of Pakistani Medical Journals - http://www.pakmedinet.com