Published online Aug 16, 2022. doi: 10.12998/wjcc.v10.i23.8124
Peer-review started: December 17, 2021
First decision: February 21, 2022
Revised: March 2, 2022
Accepted: June 30, 2022
Article in press: June, 30, 2022
Published online: August 16, 2022
Processing time: 227 Days and 2.5 Hours
Spontaneous pneumoperitoneum (SP) without gastrointestinal perforation rarely occurs in neonates, with most cases being idiopathic. Although it usually follows a benign clinical course with favorable prognosis, it can become life-threatening in certain situations.
SP is associated with a higher mortality rate than pneumoperitoneum secondary to gastrointestinal perforation, and this rate was higher than that reported by previous studies.
To demonstrate the distinct clinical features of SP to guide appropriate management by comparing characteristics between SP and typical pneumoperitoneum secondary to gastrointestinal perforation.
Retrospectively reviewed electronic medical records and identified 37 neonates with radiological evidence of pneumoperitoneum who were treated at our institution. Clinical variables were compared between neonates with SP without gastrointestinal perforation (Group A) and those with pneumoperitoneum secondary to gastrointestinal perforation (Group B).
Compared to a pneumoperitoneum secondary to gastrointestinal perforation, SP showed some specific clinical features: (1) A high association with proceeding clinical condition, persisted pulmonary hypertension and pneumothorax; (2) Frequently accompanied with a thrombocytopenia and lower partial pressure of arterial oxygen; and (3) A high mortality, especially in preterm neonates.
This study identified a higher mortality rate in patients with SP than that described in previous reports. Neonates with SP were more likely to have thrombocytopenia, pneumothorax, and persistent pulmonary hypertension. Prematurity was the most significant factor affecting mortality.
There were a few limitations: First, this was a retrospective study conducted at a single institution and all diagnoses were based solely on radiologic findings; second, the sample size was small which may limit the interpretation of the results; third, the results are limited by the lack of a comparative study for this clinical situation with inclusion of a control group without pneumoperitoneum. Nevertheless, this study is valuable as it furthers our understanding of the distinctive features of SP.