article · International Journal of Surgery Case Reports
Idiopathic pneumoperitoneum can develop in full-term newborn infants following the non-invasive administration of pure oxygen. In this documented clinical case, a full-term neonate received pure oxygen through a nasal cannula to address respiratory distress caused by laryngomalacia. The infant progressively developed abdominal distension, and a plain X-ray revealed massive free gas within the abdominal cavity, despite the complete absence of classical peritonitis signs such as fever, tenderness, or redness. While preparations for surgical exploration were underway, the distension began to regress. The condition was diagnosed as idiopathic pneumoperitoneum and treated conservatively alongside the laryngomalacia, avoiding surgery entirely. Six months after admission, the infant experienced a favourable recovery with no recorded complications. Recognising this mechanism helps clinicians avoid unnecessary operations.
Abdominal air in newborns typically prompts emergency surgery to address suspected bowel perforation. Recognising that pure oxygen therapy can induce self-resolving pneumoperitoneum without an underlying perforation allows clinicians to safely adopt conservative management. This understanding protects fragile neonates from the risks, trauma, and potential complications of unnecessary surgical procedures.
The abstract does not indicate an application or commercialisation pathway. The findings are clinical observations relevant to hospital neonatologists, paediatric surgeons, and intensive care teams managing neonatal respiratory support, with value residing in clinical decision-making rather than commercial technology.
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Introduction and clinical importance: Idiopathic pneumoperitoneum can occur in a full-term neonate due to the administration of pure oxygen. Recognition of this rare mechanism is necessary to avoid unnecessary surgical exploration. Case presentation: = 1.00) via a nasal cannula. He progressively developed abdominal distension, but had no fever, abdominal tenderness, or redness. A massive pneumoperitoneum was noted on a plain X-ray. While preparing for surgical exploration, the distension regressed, and idiopathic pneumoperitoneum was diagnosed and managed conservatively. The respiratory distress was caused by laryngomalacia, which was also managed conservatively, with no complications noted 6 months after admission. Clinical discussion: Idiopathic pneumoperitoneum should be suspected in neonates with a history of respiratory distress but without classic clinical signs of peritonitis. Notably, noninvasive administration of pure oxygen alone can cause idiopathic pneumoperitoneum. Conclusion: In a full-term neonate, non-invasive administration of pure oxygen for laryngomalacia can cause idiopathic pneumoperitoneum, which may have a favorable outcome with conservative management.
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DOI: 10.1097/rc9.0000000000000800
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