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 and US of spontaneous intestinal perforation with dirty ascites — AXR AP (above left) shows a nasogastric tube projecting over the left upper quadrant of the abdomen. There is a collection of air in the mid-abdomen that does not appear to conform to being within bowel. There is no portal venous gas or pneumatosis intestinalis. Transverse US of the abdomen (above right) shows echogenic ascites in the abdomen surrounding the loops of bowel. AXR left lateral decubitus (below) shows a large amount of air between the abdominal wall and the liver. Subsequent placement of a surgical drain returned stool.

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.

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