BMJ Case Reports 2018; doi:10.1136/bcr-2018-224398
  • Findings that shed new light on the possible pathogenesis of a disease or an adverse effect

Pneumoperitoneum in a neonate weighing less than 500 g. What do we really know about it?

  1. Cristine Sortica da Costa1
  1. 1Neonatal Intensive Care Unit, Addenbrooke’s Hospital, Cambridge, UK
  2. 2Emergência e Catástrofe, Escola Superior de Enfermagem de Lisboa, Lisboa, Portugal
  1. Correspondence to Dr Audrienne Sammut Dr, audrienne.sammut{at}
  • Accepted 26 April 2018
  • Published 16 May 2018


Pneumoperitoneum in preterm infants is a surgical emergency as it is usually indicative of intestinal perforation. Rare cases of idiopathic pneumoperitoneum have been described in the literature, the underlying causes and pathophysiology of which remain uncertain. We present a case of pneumoperitoneum in an extremely preterm infant with severe growth restriction. This occurred while she was receiving high frequency oscillatory ventilation. She had respiratory distress syndrome with pulmonary interstitial emphysema. The pneumoperitoneum occurred in isolation. Despite the insertion of two surgical drains and two exploratory laparotomies in which no obvious intestinal perforation was noted, the free air in the abdomen reaccumulated. A decision was made to manage it conservatively. She was successfully extubated on the fourth week of life and the pneumoperitoneum resolved spontaneously. She was discharged home on day 136 of life. This case highlights our limited understanding of the intricate physiology of extremely low birthweight preterm neonates.


  • Contributors AS drafted the initial manuscript. MSO, CJ and CSdC revised the manuscript. All authors were involved in the clinical care of the infant. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Parental/guardian consent obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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