Spontaneous pneumoperitoneum: Discerning from radiological imaging


  • Rahul Gupta Department of Paediatric Surgery, SMS Medical College, Jaipur, Rajasthan, India




Mechanical ventilation, Neonate, Rigler sign, Spontaneous pneumoperitoneum


Background: Pneumoperitoneum without any gastrointestinal (GI) perforation or peritonitis is entitled spontaneous pneumoperitoneum. We aimed to describe a radiological perspective in spontaneous pneumoperitoneum.

Methods: This case series presented data of 4 cases of spontaneous pneumoperitoneum managed at our institution.

Results: There were 85 patients with a provisional diagnosis of necrotizing enterocolitis (NEC) and/or pneumoperitoneum. Out of these, there were 4 patients with the final diagnosis of spontaneous pneumoperitoneum; three males and 1 female. At presentation, respiratory distress was seen in 3. It was preceded by mechanical ventilation in 3 patients. All 4 had soft abdominal distension, absence of features suggestive of peritonitis, and the presence of free air with an absence of air-fluid level in peritoneal cavity on erect abdominal radiographs. The Rigler sign was present in 3 patients. Abdominocentesis followed by abdominal drain placement was performed in 2 patients. Laparotomy was performed in 1 patient which could not point to any pathology (negative). An unfavorable outcome was seen in one patient with associated esophageal atresia. No patient had any evidence (either ultrasound/radiological or on laparotomy) of leakage of contents from the GI tract.

Conclusions: In infants, especially preterm neonates, presenting with soft abdominal distension with abrupt onset of pneumoperitoneum, without clinical features of peritonitis and preceded by mechanical ventilation, diagnosis of spontaneous pneumoperitoneum should be considered.


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Author Biography

Rahul Gupta, Department of Paediatric Surgery, SMS Medical College, Jaipur, Rajasthan, India

Assistant Professor


Duan SX, Sun ZB, Wang GH, Zhong J, Ou WH, Fu MX, et al. Diagnosis and treatment of pediatric benign pneumoperitoneum: A case report series of 9 patients. Medicine. 2017; 96:e5814.

Gupta R, Bihari Sharma S, Golash P, Yadav R, Gandhi D. Pneumoperitoneum in the newborn: Is surgical intervention always indicated? J Neonatal Surg. 2014; 3:32.

Gupta R. Spontaneous pneumoperitoneum in pediatric patients: Dilemmas in Management. J Indian Assoc Pediatr Surg. 2018; 23:115-22.

Epelman M, Daneman A, Navarro OM, Morag I, Moore AM, Kim JH, et al. Necrotizing enterocolitis: Review of state-of-the-art imaging findings with pathologic correlation. RadioGraphics. 2007; 27:285-305.

Morrison SC, Jacobson JM. The radiology of necrotising enterocolitis. Clinics in Perinatol. 1994; 21:347-63.

Prasad GR, Aziz A. Abdominal plain radiograph in neonatal intestinal obstruction. J Neonatal Surg. 2017; 6:6. Available from: https://doi.org/10.21699/jns.v6i1.483.

Pandey A, Singh SP, Gupta V, Verma R. Conservative management of pneumoperitoneum in necrotising enterocolitis- is it possible? J Neonatal Surg. 2016; 5:12.

Čečka F, Šubrt Z, Sotona O. How to distinguish between surgical and non-surgical pneumoperitoneum? Signa Vitae. 2014; 9:9-15.

Gopagondanahalli KR, Si Min SG, Chandran S, Sai Prasad TR. Do pneumoperitoneum in a stable extreme low-birth-weight infant always need laparotomy? A clinical conundrum. Med J DY Patil Vidyapeeth 2020; 13:564-6.

Bakal U, Aydin M, Orman A, Taskin E, Kazez A. A non-surgical condition of neonatal pneumoperitoneum: retroperitoneal free air secondary to massive tension pneumothorax. J Med Cases. 2016; 7:13-4.



How to Cite

Gupta R. Spontaneous pneumoperitoneum: Discerning from radiological imaging. J Neonatal Surg [Internet]. 2021Jan.10 [cited 2024Jul.22];10:6. Available from: https://jneonatalsurg.com/ojs/index.php/jns/article/view/930

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