Pneumoperitoneum in a premature neonate

Case contributed by Dr Nafisa Shakir Batta

Presentation

27th week premature neonate with resolving hyaline membrane disease, shows sudden abdominal distension.

Patient Data

Age: 8 days
Gender: Male
Modality: X-ray

See below

Case Discussion

Laprotomy revealed a solitary ileal perforation.

Pneumoperitoneum is a surgical emergency, and hence its imperative to be familiar with the Xray appearance of free intraabdominal air on erect, supine and lateral decubitus views. The importance of supine radiographic interpretation has been emphasised in neonates and infants where erect Xrays are seldom opted for.

Various signs have been described on supine and erect radiographs, namely

  • Cupola sign- pathognomic on erect views only.
  • Riglers sign
  • Liver signs : Anterior subhepatic linear air, Morrisons pouch air ( Doges cap sign), Lucent liver sign, liver edge sign.
  • Football sign
  • Falciform ligament sign
  • Urachus sign
  • Coronary ligament outlined by air
  • Continuous diaphragm sign
  • Triangle sign
  • Dancing/Leaping dolphin sign at diaphragmatic muscle slips
  • Inverted V sign
  • Scrotal air
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Case Information

rID: 26345
Case created: 14th Dec 2013
Last edited: 18th Sep 2015
Inclusion in quiz mode: Included

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