Pediatric Spontaneous Intestinal Perforation

Etiology:
— Bowel perforation in neonates without demonstrable cause,
— Healthy bowel at perforation site which is most often at terminal ileum
— Distinct from necrotizing enterocolitis – could it be due to transient intestinal ischemia from hypoperfusion
Imaging AXR: Often have large volume of free air
DDX:
Complications:
Treatment: Surgical
Clinical:
— In neonates
— Risk factors are prematurity, chorioamnionitis, post natal steroids, possibly indomethacin

Radiology Cases of Spontaneous Intestinal Perforation

AXR of pneumoperitoneum — Right lateral decubitus radiograph of the abdomen shows a large amount of free air within the abdomen.

CXR and AXR of pneumoperitoneum — CXR AP (above) shows increased lucency in the upper abdomen. Left lateral decubitus AXR (below) shows a large amount of free air between the abdominal wall and the liver.

AXR of esophageal perforation from nasogastric tube placement — Supine AXR (above) shows increased lucency in the upper abdomen. The cross-table lateral AXR (below) shows air between the anterior abdominal wall and the bowel. The nasogastric tube follows a very straight course and does not curve towards the stomach. Note on both views that the tip of the nasogastric tube does not project over the stomach. US performed subsequently showed the tip of the nasogastric tube was in the retroperitoneum and not in the stomach.