Abstract
Acute appendicitis is rare in the neonatal population, and delayed diagnosis is associated with increased morbidity and mortality. Pneumoperitoneum is infrequently identified on plain radiography in cases of neonatal appendicitis, which can result in delays in diagnosis and intervention. In this case, we report a 15-day-old preterm female neonate who presented with irritability and abdominal distention. A plain abdominal radiograph demonstrated significant pneumoperitoneum, and surgical exploration revealed perforated appendicitis.