Presentation
A micro-premature neonate with acute abdominal distention and respiratory compromise.
Patient Data
Features consistent with a large tension pneumoperitoneum with an elevated diaphragm and bulging flanks. There is a background of severe surfactant deficiency disorder and superadded congenital pneumonia. Ill-defined and magnified cardiomediastinal controur.The ETT is satisfactorily sited at T2/T3 vertebral body level. The nasogastric tube is suspiciously sited within the left flank. The umbilical arterial line is satisfactorily sited at T8 vertebral level. There is a right axillary central line, the tip is poorly identified. There is an overlying temperature probe.
Case Discussion
A mico-premature baby, born at 24 weeks gestation. The baby developed an acute bowel perforation with a large tension pneumoperitoneum. The patient developed further cardiorespiratory compromise aggravating the background surfactant deficiency disorder and congenital pneumonia. The nasogastric tube appeared eccentric within the left iliac fossa but was intragastric at the time of surgical intervention with an intact stomach. The exact site of perforation was not conveyed to us post-surgery. Mechanical ventilation and/ or NEC were possible etiologies in this neonate. Note the presence of multiple signs of a pneumoperitoneum specifically, continuous diaphragm sign, football sign, hepatic edge sign, lucent liver sign, and a Doge cap sign. Note the presence of free air outlining the scrotum due to the patent processus vaginalis in this micro-premature neonate.
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