A premature male newborn developed pneumoperitoneum 22h after birth. His mother, a G1P0 patient carrying monochorionic-monoamniotic twins, was admitted to our hospital for premature labor after 33 weeks of gestation. The twins had entangled umbilical cords and the subject was at risk of fetal distress；therefore, he was delivered by elective cesarean section.. His birth weight was 1798g and his Apgar score was 8 at 1min and 9 at 5min. He suffered from mild respiratory distress and was treated with surfactant. When he was extubated, his thoracoabdominal X-ray showed pneumoperitoneum. Accordingly, abdominal drainage was performed and oral feeding was stopped, but his condition did not improve. An exploratory laparotomy was performed on the seventh day after his birth, revealing a perforated MD located 15cm from the ileocecal valve and mild peritonitis with free meconium in the abdominal cavity. After the patient recovered from the operation, oral feeding was started, and he was discharged 36 days after birth.
Neonatal gastrointestinal perforation is not rare, especially among premature neonates, and because of its poor prognosis, exploratory laparotomy is often mandatory.
MD is a rare cause of neonatal gastrointestinal perforation. In this case, the etiology of the MD perforation was not identified clearly, but the pathophysiological features resembled those of FIP and progressed through a gradual clinical course. In cases like this, peritoneal drainage could be an effective treatment, though the possibility of subsequent laparotomy should be considered. This case should draw increased attention to the problems associated with differential diagnosis of acute abdomen in newborn.
