Neonatal Meconium Plug Caused Severe Proximal Small Bowel Dilatation and Made A Misinterpretation of Pneumoperitoneum

There is a high mortality rate for infants with visceral perforations. Clinical imaging of this condition includes free air in the abdomen with abdominal plain radiography or lateral decubitus radiographs. An important disease that is easily ignored in the perinatal period is meconium plug syndrome, which causes functional obstruction in the colon that leads to dilated bowel loops in abdominal plain radiography. We report a female newborn who had a suspected bowel obstruction during prenatal examination because of polyhydramnios. The initial plain abdominal film showed a large volume of air accumulation in the peritoneum. An emergent exploratory laparotomy was performed and it revealed that there was no free a3 ir nor ascites in the peritoneal cavity. The proximal small bowel was severely dilated and a meconium plug at the splenic flexure was found. The image of air in the patient's small bowel and peritoneal cavity in the anterior-posterior view and image of the left decubitus view of the abdomen were similar in this case to the degree that the clinicians could not differentiate them, leading to an unnecessary exploration laparotomy.