Neonatal pneumoperitoneum secondary to perforated necrotizing enterocolitis

Case contributed by Alice Spencer
Diagnosis certain


8 day male presenting with distended abdomen and metabolic acidosis, born at 29+3 weeks.

Patient Data

Age: 8 days
Gender: Male

The lungs are small in volume with granular appearances, which are in keeping with respiratory distress syndrome.

The bowel has a bubbly appearance suspicious for necrotizing enterocolitis/pneumatosis.
Ill-defined lucency in the center of the abdomen, highlighting the falciform ligament, which is in keeping with pneumoperitoneum.

This is confirmed on the lateral view, with accumulation of air in the anti-dependent positon.
Subtle lucencies projected in the liver, which are in keeping with portal venous gas.

The tip of the nasogastric tube is projected below the left hemidiaphragm in the stomach.
The tip of the UVC is projected at the ductus venosus/IVC , just below the level of the hemidiaphragm.

Respiratory distress syndrome.
Necrotizing enterocolitis with pneumoperitoneum.

Case Discussion

AP supine and lateral X-rays taken of 8 day male neonate born at 29+3 weeks, presenting with abdominal distention and worsening metabolic acidosis. X-rays demonstrate necrotizing enterocolitis with perforation, and resulting pneumoperitoneum (seen as the football sign on AP view with visible falciform ligament, and elucidated on lateral film). This child was transferred to a tertiary neonatal center for follow up care.

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