The conservative management of pneumoperitoneum in children / 中国小儿急救医学

ABSTRACT

Objective Pneumoperitoneum is usually the result of hollow visceral perforation and requires emergent laparotomy.However,about 10％ of patients lack a pathologic cause requiring surgical intervention and can be resolved with conservative management.The aim of this study is to discuss the indications for conservative management of pneumoperitoneum in children.Methods We retrospectively reviewed the data of 5 children with pneumoperitoneum without peritonitis treated in our pediatric surgery department between January 2009 and December 2010.Results There were 5 children with an average age 5.4 years.Radiologic examinations demonstrated pneumoperitoneum and visceral perforations were suspected in the local hospitals.The abdominal examination revealed no peritoneal signs in all patients.Among them,peritoneal aspirations were implemented in 4 patients and the results were negative.One of five patients underwent laparotomy that demonstrated no visceral perforation.The remaining four were successfully managed conservatively and the pneumoperitoneum was completely resolved between 3 and 9 days.All children were without abdominal symptoms and signs throughout at least 2 years follow-up.Conclusion The presence of free intraperitoneal air does not always indicate hollow visceral perforation and the need for emergent laparotomy.It appears that therapeutic effectiveness can be readily achieved with conservative management in children with pneumoperitoneum without peritonitis.