Massive Pneumoperitoneum in Neonate a Case Report in Owerri

Massive pneumoperitoneum in a neonate should be treated as an emergency; immediate action of management should be applied as soon as the diagnosis is made. A four day old male neonate was admitted into the intensive care baby unit (ICBU) with severe birth asphyxia, anaemia and sepsis. An exchange blood transfusion was done due to the anaemia and sepsis. The following morning, patient vomited twice after food, feeds where consequently withheld and baby was on nil per oral with intravenous infusion. By evening the patient developed fever and passed non-bloody buy foul smelling meconium. That same night (5th day of life), the abdomen became distended and quite tense that the abdominal organs were difficult to palpate. Abdominal radiography showed bulging of the flanks; a large amount of free gas was seen under the diaphragm which compressed the abdominal viscera caudally and medially. A diagnosis of massive pneumoperitoneum was made, an emergency laparotomy was done; a longitudinal tear, about 9cm long was found in the descending colon, another perforation with necrotic border was found in the sigmoid colon with faecal soilage all over the peritoneal cavity. The affected segments of the colon were resected and transverse colosigmoid anastomosis was done, colostomy was not constructed because of the condition of the baby and poor management of colostomy in the environment. Post operative recovery was uneventful; the patient was discharged on the 29th post operative day at age of 6 weeks.