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Tension pneumoperitoneum: bedside management and safe transfer

Figure 1 Pneumoperitoneum and distended bladder. CPAP. Apgar score was 31 and 95. On day 2 of life she developed tense abdominal distension with erythema. An abdominal X-ray showed a large pneumoperitoneum [1]. She was re-ventilated and transferred to our tertiary referral centre for surgical management. On arrival a further X-ray of the chest and abdomen was performed (Fig. 1). This showed a large pneumoperitoneum, a full bladder, and compression of the lungs by the raised diaphragm. Her blood gas results on admission demonstrated a mixed acidosis with marked respiratory component (Table 1). The bladder was catheterized and the tension pneumoperitoneum drained using a 22-G cannula inserted into the left iliac fossa. Following these interventions, the abdominal distension completely resolved and ventilation was significantly improved prior to further transfer to the operating theatre for a laparotomy (Table 1). At laparotomy an isolated ileal perforation was noted and an ileostomy created. Histology demonstrated necrotizing enterocolitis. Large amounts of free air in the abdominal cavity (tension pneumoperitoneum) can cause respiratory compromise by impairing diaphragmatic excursion and lung compression. Cardiovascular compromise can occur due to compression