Clinical spectrum of neonates presenting with pneumoperitoneum: A retrospective study

Background: Neonatal pneumoperitoneum is attributed, in most of the reported cases, to necrotising enterocolitis (NEC). There are also other causes leading to free intraperitoneal air. The aim of this study is to describe the clinical spectrum, causes, management and outcome of neonates admitted with pneumoperitoneum in the paediatric surgery unit of a university hospital. Subjects and Methods: This retrospective study included neonates having radiographic evidences of pneumoperitoneum from 2012 to the end of 2014. Patients' files were analysed regarding age at admission, birth weight, history, clinical picture, management, operative findings and subsequent outcome. Results: Fifty-six out of 379 neonates (14.7%) were found to have pneumoperitoneum during the study period. There were 35 males (62.5%) and 21 females (37.5%). Cases diagnosed as NEC represented 27 neonates (48.2%). There were 29 cases (51.8%) with causes not related to NEC. Non-NEC causes were spontaneous intestinal perforation (8.9%), ano-rectal malformations (7.1%), Hirschsprung's disease (14.2%), ileal atresia (3.5%), incarcerated inguinal hernia (1.7%), gastric perforation (1.7%) and meconium ileus (1.7%). In seven patients (12.5%), those who were managed conservatively (8.9%) or whose laparotomy was negative (3.6%), no cause of pneumoperitoneum could be reached. Overall mortality was 25%, 78.5% of which was NEC-related. Conclusions: Neonatal pneumoperitoneum is an alerting finding for paediatric surgeons. Most cases imply serious causes with a significant morbidity and mortality, NEC being the most common cause. On the other hand, pneumoperitoneum is not an absolute indication for surgery. Careful assessment and tailored management can limit the morbidity of unnecessary laparotomies.