Abstract
The presence of air in the peritoneal cavity demonstrated radiographically as the crescent of air under the diaphragm is termed pneumoperitoneum. The causative agents may be divided into spontaneous, traumatic, iatrogenic, and miscellaneous. The majority (∼ 90%) of cases are attributed to hollow viscus perforation which requires immediate surgical attention. Neonatal pneumoperitoneum is a surgical emergency unless proven otherwise. A distinct entity termed benign pneumoperitoneum occurs in the absence of clinical and paraclinical features of peritonitis. Benign pneumoperitoneum may be caused by various thoracic, abdominal, and gynecological conditions. In neonates with respiratory distress pneumoperitoneum is a frequent association especially when treated with mechanical ventilation. The air leak phenomenon leads to air tracking from the ruptured alveoli along the interstitium to the mediastinum then to the retroperitoneum and ultimately into the peritoneal cavity. Such patients usually do not require surgical intervention and are managed conservatively. Knowledge of the existence of benign pneumoperitoneum helps to avoid unnecessary surgery thereby reducing operative morbidity and mortality.