Perforated Meckel's diverticulum as a cause of pneumoperitoneum in a VLBW new-born

Abstract We report the case of a preterm weighting 755g who showed a massive pneumoperitoneum 14 hours after birth without clinical signs of an Necrotizing enterocolitis (NEC). In surgery, a round hole with everted edges was found in the middle course of the small bowel without surrounding ischemic necrosis or significant peritonitis. The child was successfully treated with resection and anastomosis, with uneventful short-term postoperative recovery. Both macroscopic and microscopic features were consistent with a perforation of the Meckel remnant. The theoretical etiopathogenesis of this uncommon pathology and the predisposing factors in the preterm population are discussed as well as the treatment. The few cases reported in literature, including the present case, which is the smallest one described to date, encourage consideration of a perforated Meckel's diverticulum as one of the possible causes of free peritoneal air in preterm new-borns, separate from the consequences of an NEC.