Abstract
Pneumoperitoneum is typically caused by breached hollow viscera and necessitates surgical intervention. This may have various etiologies, including spontaneous, necrotizing enterocolitis (NEC), and obstruction. In these cases, spontaneous intestinal perforation (SIP) is a unique clinical entity with a better outcome than newborns with NEC-related intestinal perforation. Here, we present a rare case of SIP manifested in the form of pneumoperitoneum in the first eight hours of life, emphasizing the importance of differentiation between NEC and SIP, as each condition has variable treatment options and outcome considerations.