Extra-peritoneal air mimicking pneumoperitoneum in an infant

About 10% of cases of pneumoperitoneum are not associated with a hollow viscus breach. Here we present a rare cause due to a gas-forming organism in a 45 day-old male patient. He presented with severe abdominal distension and poor general condition that started at day 10 of life. Erect abdominal x-rays revealed pneumoperitoneum. A chronic abscess cavity was found on exploration and the underlying gut was healthy. The cavity was evacuated and a drain left in-situ. Culture and sensitivity reported Escherichia coli and Pseudomonas aeruginosa. The baby tolerated full oral feeds 48 h after the procedure. His general condition improved with the appropriate antibiotics