[An infant with intestinal pneumatosis and pneumoperitoneum: the difficult decision not to intervene]

Tension pneumoperitoneum caused by rupture of intraabdominal soft tissue emphysema in a child supported with high-frequency oscillatory ventilation: a case report

Background

We reported a case with tension pneumoperitoneum while being on high-frequency oscillatory ventilation.

Case presentation

A 12-month-old Thai girl presented with acute respiratory distress syndrome, septic shock, and bacterial pneumonia. Although supported with mechanical ventilation, she still had severe hypoxia. She was then transitioned to high-frequency oscillatory ventilation. During a weaning period on day 7, she developed left tension pneumothorax requiring intercostal drainage and a markedly large amount of pneumoperitoneum. In spite of a bedside abdominocentesis, her abdomen was still tense and her hemodynamics was unstable. Subsequently, to exclude hollow viscus perforation, diaphragmatic injury caused by intercostal drainage, or abdominal compartment syndrome, she was transferred for surgery. There was no intestinal perforation. Postoperatively, she was on oxygen therapy, on chest physical therapy, and kept hemodynamically stable until she had recovered.

Conclusion

A case of tension pneumoperitoneum probably caused by high-frequency oscillatory ventilation was reported. Awareness of this condition should be included in the differential diagnosis.