Pneumoperitoneum Following Duodenal Atresia Repair: A Rare But Serious Complication in Neonates

Background: Ventilation management in the immediate post-operative period following duodenal atresia repair in neonates has not been well studied.We report on two cases of postoperative pneumoperitoneum following duodenal atresia (DA) repair in neonates.In both cases, the use of noninvasive ventilation (NIV) was associated with the complication of pneumoperitoneum.Case Presentation: The first neonate was born preterm at 31 weeks gestation with Trisomy 21, complete atrioventricular septal defect (AVSD), and duodenal atresia.He was intubated for DA repair and was extubated and placed on noninvasive neurally adjusted ventilatory assist (NI-NAVA) on postoperative day two.On postoperative day four, he developed abdominal distention and hypoxemia.Abdominal imaging showed a pneumoperitoneum.Exploratory laparotomy was performed to repair a leak at the anastomotic site.The second case was a term infant with duodenal atresia, myelomeningocele, and other dysmorphic features.She was extubated to high flow nasal cannula on the post-operative day three.Due to increasing respiratory distress, support was escalated to continuous positive airway pressure (CPAP) and then to noninvasive positive pressure ventilation (NIPPV) within a few hours.Increasing abdominal distention led to imaging and showed a pneumoperitoneum.A leak at the anastomotic site was identified and repaired. Conclusion:The post-operative complication of anastomotic leak is a rare complication of DA repair.The two cases described above demonstrate that post-operative NIV could potentially lead to air distention of the stomach and duodenum and may contribute to a leak at the anastomotic site.To our knowledge, this complication of DA repair has not been previously reported in the literature and should be considered when extubating patients to NIV in the immediate postoperative period.