The Disappearance of Free Air After Pediatric Laparotomy

The disappearance of intraperitoneal free air after pediatric laparotomy has been the subject of much talk and speculation, but little scientific publication. Moreover, there is no unanimous opinion as to the "correct" time of disappearance of such postoperative free air. Eighty-eight pediatric surgical patients ranging in age from newborn to 18 years were studied after each had a laparotomy to determine when the postoperative free intraabdominal air disappeared. Upright abdominal x-rays were taken in each patient starting on the second day after operation and these x-rays were repeated every few days until the free air was no longer visible. No more than eight such single upright abdominal x-rays were taken in any one patient, the majority having only two or three. Free air under the diaphragm(s) was the specific criterion followed until disappearance of the free air. At the time of the x-ray, the temperature was noted, as well as the presence or absence of the following: nasogastric suction, bowel sounds, flatus, stools, drains, and wound infection. The patients in this series fit into three distinct groups: all newborns and small infants had no free air seen on upright x-rays by the second postoperative day. The free air found in older infants and children operated on through small abdominal incisions (eg, McBurney) was gone in most by the third postoperative day, with the longest time being eight days. In the group of infants and children who had longer operations through larger incisions, half had no free air by two or three days, while the rest had their free air slowly disappear over a period of up to 19 days. In these latter cases, there was a prolonged intestinal ileus. It is our conclusion that free air in and of itself in an otherwise well infant or child after laparotomy need not cause undue alarm. In addition, there seems to be a correlation between the persistance of free air on one hand, and age, thin habitus, size of incision, length of operation, and adynamic ileus on the other hand.