Objective Pneumoperitoneum is usually the result of hollow visceral perforation and requires emergent laparotomy.However,about 10％ of patients lack a pathologic cause requiring surgical intervention and can be resolved with conservative management.The aim of this study is to discuss the indications for conservative management of pneumoperitoneum in children.Methods We retrospectively reviewed the data of 5 children with pneumoperitoneum without peritonitis treated in our pediatric surgery department between January 2009 and December 2010.Results There were 5 children with an average age 5.4 years.Radiologic examinations demonstrated pneumoperitoneum and visceral perforations were suspected in the local hospitals.The abdominal examination revealed no peritoneal signs in all patients.Among them,peritoneal aspirations were implemented in 4 patients and the results were negative.One of five patients underwent laparotomy that demonstrated no visceral perforation.The remaining four were successfully managed conservatively and the pneumoperitoneum was completely resolved between 3 and 9 days.All children were without abdominal symptoms and signs throughout at least 2 years follow-up.Conclusion The presence of free intraperitoneal air does not always indicate hollow visceral perforation and the need for emergent laparotomy.It appears that therapeutic effectiveness can be readily achieved with conservative management in children with pneumoperitoneum without peritonitis.

Objective To explore the colonic motor function of children with chronic constipation. Methods Twenty-five constipation children were enrolled in this study receiving determination of the colonic transit time and the anorectal vector manometry. Patients were then divided into subgroups with prolonged transit time and that with normal transit time. The value of anorectal manometry was assessed in these two subgroups. Results The total gastrointestinal transit time (TGITT), Left colonic transit time (LCTT)and rectosigmoid colonic transit time (RSTT) in constipation children were significantly longer than those measured in 33 healthy controls: (92?56) h vs. (29?8) h,P

Objective To explore the stooling patterns and sphincter function after transanal one-stage pull through operation for Hirschsprung's disease in children. Methods In this study, 73 children patients averagely aging at 24. 7 months underwent transanal one-stage pull through operation for common type Hirschsprung' s disease. Fifty-eight postoperative patients were followed up for an average of 15. 8 months. Stooling pattern was investigated with the informed questionnaire, according the result patients were divided into symptomatic and nonsymptomatic group. The rectoanal inhibitory reflex ( RIR) and vector manometry including the maximal anal pressure in resting and squeezing, the vector volume ( VV) and vector symmetric index ( VSI) were performed to explore the postoperative stooling patterns and sphincter function. Results Stooling patterns were fine in most patients, postoperative soiling was found in 9 cases, constipation in 5 and Hirschsprung-associated enterocolitis in 3, there was no incontinence. The rectoanal inhibitory reflex recovered in 5 children. The vector manometry showed the maximal anal pressure of the constipated group in resting and squeezing were both higher than those of nonsymptomatic and control group (167?36vs. 157 ?47 vs. 152 ?33,P