One-time needle aspiration: a safe and effective treatment for neonatal spontaneous pneumoperitoneum

Abstract

Introduction: Pneumoperitoneum is a rare surgical emergency to be seen in the neonates, occurring most commonly secondary to necrotizing enterocolitis (NEC). The term spontaneous or non-surgical pneumoperitoneum is used for cases not associated with a perforated viscus. Recommended treatment options for the former is primary peritoneal drainage (PPD) and exploratory laparotomy. Our study evaluates one-time needle aspiration alone through the right hypochondrium for effective management of the pneumoperitoneum in neonates.

Material and methods: Twenty neonates presenting to the emergency department with massive pneumoperitoneum and respiratory distress were subjected to one-time needle aspiration of the peritoneal cavity. Effectiveness of the intervention was defined by decompression of abdominal distension, permanent disappearance of free intra-peritoneal air, cessation of non-bilious aspirates and complete haemodynamic stability during the 48-hour period following the procedure.

Results: All 20 neonates improved initially with abdominal decompression by virtue of improvement in respiratory function. Of the 20 neonates, 6 neonates with spontaneous pneumoperitoneum (SIP) made a rapid recovery and needed no further surgical intervention; thereby the procedure was labeled as “effective”. In the remaining 14 patients (with NEC and perforated bowel), free peritoneal air re-appeared in the next 24-48 hour period and PPD/exploratory laparotomy had to be performed. Feeds were established earlier (approximately 2 days) and mean hospital stay was significantly shorter in the group with “effective” procedure (by 3 days). Four neonates expired in postoperative period in the group requiring surgery.

Conclusion: One-time needle aspiration can serve as an effective treatment for neonates with spontaneous pneumoperitoneum and can obviate the need for exploratory laparotomy in small sick neonates with SIP who carry poor risk for extensive surgical intervention.