Fazal H Khan, M Nadeem Ahmad.
Pneumoperitoneum Following Mechanical Ventilation in a Child.
J Coll Physicians Surg Pak Nov ;11(8):508-10.

A case of spontaneous pneumoperitoneum in a 5 months old child is being described. This child developed massive pneumoperitoneum while being mechanically ventilated. This possibility should always be kept in mind specially if child develops pneumoperitoneum in the presence of very high airway pressures.

A 5 month old baby girl with a history of loose motions and fever for 1 week was presented in the emergency room of our hospital. Her past medical history was unremarkable. On examination she was restless, her heart rate was 140/min, respiratory rate was 65/min, and oxygen saturation 59%. Her blood pressure was 100/60. She had a cardiopulmonary arrest in the emergency room. She was resuscitated and shifted to ICU and put on mechanical ventilation. Further examination and investigations revealed that she was suffering from rickets, pneumonia and hypocalcemia.

One the 1st day of admission, she was put on pressure control ventilation. Her pressure control was set at 8 cms H20, respiratory rate was 20/min, FiO2 was kept at 0.5. Her arterial blood gases were showing a pH of 7.43, PaCO2 of 32 mmHg, PaO2 of 80 mmHg, HCO3 was 21 meq/l and SaO2 was 98%. Her chest x-ray revealed evidence of surgical emphysema in the neck and hyperinflation in both lungs.

On 3rd day in the ICU deterioration in lung function was noted. Her chest x-ray revealed pneumomediastinum and irregular densities in the lung field suggesting onset of respiratory distress syndrome.

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