Chukwubuike Kevin Emeka1*, Igweagu Chukwuma Paulinus2 and Anijunsi Livinus Patrick1

Background: Hollow viscus perforation constitutes a frequent surgical emergency and this may results in pneumoperitoneum (free intraperitoneal gas). The aim of this study was to evaluate the preoperative radiographs of children who were operated upon for perforated hollow viscus, with regards to air under the diaphragm.
Materials and Methods: This was a retrospective study of children aged 15 years and younger who were managed for perforated hollow viscus at the pediatric surgery unit of a teaching hospital in Enugu, Nigeria. The information extracted included the patients’ age, gender, presenting symptoms, duration of symptoms before presentation, time interval between presentation and intervention, intra-operative finding/definitive diagnosis, definitive operative procedure performed, complications of treatment, duration of hospital stay and outcome of treatment.
Results: A total of 204 cases of perforated hollow viscus were managed during the study period. More males were affected. Abdominal pain was a consistent symptom in the patients. Free air under the diaphragm was observed in 62 (30.4%) patients whereas there was no free air under the diaphragm in 142 (69.6%) patients. Typhoid intestinal perforation and wound infection were the most common cause of hollow viscus perforation and post-operative complication respectively. About one-tenth of the patients expired following severe sepsis, renal compromise and anesthesia related complication.
Conclusion: Hollow viscus perforation manifests as free air in the peritoneal cavity (pneumoperitonem) and is usually an indication for surgical abdominal exploration. However, in the present study, only about one-third of the children with confirmed hollow viscus perforation (at surgery) showed pneumoperitoneum in their preoperative chest radiographs.

Keywords: Children, diaphragm, free air, perforated viscus, penumoperitoneum.

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