Postoperative pneumoperitoneum in children: two clinical cases as an example

BACKGROUND: The literature describes various causes of free gas in the abdominal cavity, or pneumoperitoneum, in the immediate postoperative period. In such cases, surgeons should find out if the residual gas is postoperative pneumoperitoneum, or it is some postoperative complication requiring surgical intervention. In the present article, the authors describe two clinical cases of pneumoperitoneum in children after elective surgeries.

CLINICAL CASE DESCRIPTION: First case: free gas was fund in a 6-year-old child at ultrasound examination and overview radiography of the abdominal organs. Perforation of some hollow organ was suspected. After conservative measures (infusion therapy with glucose-salt solution, anesthesia, cleansing enema), which did not give any positive dynamics, diagnostic laparoscopy was performed. No perforation in genital organs was detected. On the second postoperative day, the child was discharged in the satisfactory state.

Second case: ultrasound examination and overview radiography of the abdominal organs revealed free gas under the diaphragm dome in a 13-year-old patient. Taking into account the clinical picture and instrumental diagnostic findings, diagnostic laparoscopy was performed which revealed swollen intestinal loops without signs of perforation. The child was discharged on the third postoperative day. Control ultrasound examination of the abdominal cavity organs showed no any free gas; in the left iliac region, moderate edematous tissue 1×1.5 cm was seen.

CONCLUSION: Dynamic monitoring of patients with postoperative pneumoperitoneum and without signs of peritonitis should be performed. If there is no positive dynamics in child’s condition, diagnostic laparoscopy or laparotomy are recommended.