WOFAPS 2025 8th World Congress of Pediatric Surgery

Nabila Talat, Azwa Janjua, Aziz Ahmed Chattha, Muhammad Zubair Shoukat, Sadaf Daud, Farrukh Mehmood Star

University of child health sciences, The Childrens Hospital, Lahore

Introduction:

Infantile pneumoperitoneum most commonly results from necrotizing enterocolitis. Spontaneous duodenal perforations are exceptionally rare in this population. We present two fatal cases of duodenal perforation in 2-month-old infants who were initially treated for pneumonia.

Case Presentation:

Case 1:

A 2-month-old male baby, born at term via cesarean section, presented in medical emergency with respiratory distress and was treated for pneumonia for 4 days. On day 5, he developed acute abdominal distension. Imaging revealed pneumoperitoneum. Emergency laparotomy identified a 3mm perforation on the posteromedial surface of the second part of duodenum, just above the ampulla. Primary repair with 5-0 PDS sutures and feeding jejunostomy was done. Despite intensive care the patient developed refractory septic shock and expired 24 hours postoperatively.

Case 2:

A two months old baby born at 35 weeks via cesarean section was admitted in medical ward for complicated lower respiratory tract infection. On day 7 of treatment, he developed abdominal distention that worsened over the day. Imaging showed massive pneumoperitoneum. Exploration revealed a 2mm perforation on posteromedial aspect of second part of duodenum above ampulla. Primary repair with feeding jejunostomy was done. Despite surgical intervention, sepsis worsened, and patient could not survive.

Conclusion:

Duodenal perforation should be considered in infants with sudden pneumoperitoneum, even without obvious history of trauma or vigorous resuscitation. The anatomical proximity of the duodenum to other structures makes surgical repair particularly challenging in infants. Pneumoperitoneum in pre-existing pneumonia carries extremely high mortality. the cases emphasize the need for heightened vigilance for abdominal complications in babies receiving respiratory support.