Resolution of Free Air in the Peritoneal cavity after Laparotomy for Bowel Perforation in Children: How Long Does It Take?

Background: Preoperatively, the presence of free air in the peritoneal cavity (pneumoperitoneum) is indicative of a gastrointestinal perforation and laparotomy exposes the peritoneal cavity and bowel to atmospheric air. The aim of this study was to evaluate how long (in days) it takes for free air in the peritoneal cavity to disappear following laparotomy in children. Materials and Methods: This was a prospective study of children aged 15 years and younger who had laparotomy for bowel perforation at the pediatric surgery unit of a teaching hospital in Enugu, Nigeria. This study covered a 5-year period. The patients were followed up postoperatively to evaluate which day post op the free air in the peritoneal cavity resolves. Results: A total of 112 cases of perforated bowel had laparotomy during the study period. Amongst this number, 37 (33%) patients showed pneumoperitoneum on their preoperative radiographs and form the basis of this report. There was male predominance. Abdominal pain is a consistent symptom in all the patients. Majority of the patients had typhoid intestinal perforation with single ileal perforation and primary intestinal repair was the most performed procedure. Wound infection was the most common post-operative complication and the general outcome was fair. Overall, the mean time for the pneumoperitoneum to disappear was 5.5 days postoperatively. Conclusion: Bowel perforation results mostly from infective/inflammatory processes such as typhoid intestinal perforation. Laparotomy is required for the repair of these perforations and its takes an average of 5.5 days for the free peritoneal air to resolve.