Advertisement

Pneumoperitoneum point-of-care ultrasound findings

  • Victor Sartorius
    Correspondence
    Corresponding author. Service de Pédiatrie et Réanimation Néonatale, Hôpital A. Béclère, GHU Paris Saclay, APHP, 157 rue de la Porte de Trivaux, 92140, Clamart, France.
    Affiliations
    Division of Pediatrics and Neonatal Critical Care, “Antoine Béclère” Medical Centre, Paris Saclay University Hospitals, APHP, Clamart, France
    Search for articles by this author
  • Daniele De Luca
    Affiliations
    Division of Pediatrics and Neonatal Critical Care, “Antoine Béclère” Medical Centre, Paris Saclay University Hospitals, APHP, Clamart, France

    Physiopathology and Therapeutic Innovation Unit-INSERM U999, Paris Saclay University, Le Plessis Robinson, France
    Search for articles by this author
Open AccessPublished:May 21, 2022DOI:https://doi.org/10.1016/j.pedneo.2022.05.002
      An extremely preterm male neonate (26 weeks; 675 g) was admitted to our intensive care unit. On Day 7 of life, he presented with clinical signs of necrotizing enterocolitis (NEC), which worsened after 1 week. Point-of-care ultrasound is our first line imaging technique
      • Singh Y.
      • Tissot C.
      • Fraga M.V.
      • Yousef N.
      • Cortes R.G.
      • Lopez J.
      • et al.
      International evidence-based guidelines on point of care ultrasound (POCUS) for critically ill neonates and children issued by the POCUS working group of the European society of paediatric and neonatal intensive care (ESPNIC).
      ; therefore, an abdominal scan was immediately performed by a fellow neonatologist with a microlinear “hockey stick” high-frequency (15 MHz) probe.
      A large pneumoperitoneum (Fig. 1 and supplementary video) appeared as follows:
      Figure 1
      Figure 1Ultrasound appearance of pneumoperitoneum in an extremely preterm neonate. A hyperechogenic peritoneal line is visible at the interface between the parietal peritoneum and free intraperitoneal air. Continuous horizontal lines are observed, which represent the peritoneal line reverberation generated by the free intra-abdominal air. A “gut point” is a point from which the parietal peritoneum sliding stops and the horizontal lines appear. These signs are similar to the lung ultrasound features of a thoracic air leak: A-lines and the absence of pleural sliding.
      The following is/are the supplementary data related to this article:
      (mp4, (6.43 MB)
      Pneumoperitoneum is an NEC complication that is associated with negative outcomes. The point-of-care ultrasound algorithms to critically manage ill neonates include screening for intra-abdominal fluid; however, nothing is suggested for air detection.
      • Yousef N.
      • Singh Y.
      • De Luca D.
      “Playing it SAFE in the NICU” SAFE-R: a targeted diagnostic ultrasound protocol for the suddenly decompensating infant in the NICU.
      At present, plain abdominal radiography and ultrasound are two bedside tests that are used to confirm clinical intestinal perforation suspicion. The use of ultrasound for the prognostic evaluation of patients with NEC is widespread,
      • Cuna A.C.
      • Reddy N.
      • Robinson A.L.
      • Chan S.S.
      Bowel ultrasound for predicting surgical management of necrotizing enterocolitis: a systematic review and meta-analysis.
      although their accuracy has not been formally compared yet in neonates. However, clear ultrasound descriptions of pneumoperitoneum aspects in preterm neonates are scanty. Thus, differentiating intraluminal from free intraperitoneal air might be challenging, particularly in the smallest neonates and those with abdominal distension. In this illustrative case, the association of the aforementioned signs and the presence of free air between the liver and the abdominal wall (Fig. 1 and supplementary video) facilitated the diagnosis, which was then surgically confirmed. Therefore, such a description can be didactically valuable. Moreover, it could promote the use of ultrasound as a diagnostic adjunct for NEC.
      • Conlon T.W.
      • Nishisaki A.
      • Singh Y.
      • Bhombal S.
      • De Luca D.
      • Kessler D.O.
      • et al.
      Moving beyond the stethoscope: diagnostic point-of-care ultrasound in pediatric practice.

      Parental consent

      Written parental consent for publication of the manuscript, the images and the video was obtained and can be provided.

      Declaration of competing interest

      Authors have no conflict of interest to declare

      Acknowledgements

      The authors would like to thank Dr. Hélène Schieber and Dr. Nadya Yousef for their informative feedback on the manuscript.

      References

        • Singh Y.
        • Tissot C.
        • Fraga M.V.
        • Yousef N.
        • Cortes R.G.
        • Lopez J.
        • et al.
        International evidence-based guidelines on point of care ultrasound (POCUS) for critically ill neonates and children issued by the POCUS working group of the European society of paediatric and neonatal intensive care (ESPNIC).
        Crit Care. 2020; 24: 65
        • Yousef N.
        • Singh Y.
        • De Luca D.
        “Playing it SAFE in the NICU” SAFE-R: a targeted diagnostic ultrasound protocol for the suddenly decompensating infant in the NICU.
        Eur J Pediatr. 2022; 181: 393-398
        • Cuna A.C.
        • Reddy N.
        • Robinson A.L.
        • Chan S.S.
        Bowel ultrasound for predicting surgical management of necrotizing enterocolitis: a systematic review and meta-analysis.
        Pediatr Radiol. 2018; 48: 658-666
        • Conlon T.W.
        • Nishisaki A.
        • Singh Y.
        • Bhombal S.
        • De Luca D.
        • Kessler D.O.
        • et al.
        Moving beyond the stethoscope: diagnostic point-of-care ultrasound in pediatric practice.
        Pediatrics. 2019; 144e20191402