Massive Idiopathic Nonsurgical Pneumoperitoneum with the Football Sign in a Preterm Infant: A Case Report

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Pneumoperitoneum is the abnormal presence of air in the peritoneal cavity. In cases of massive pneumoperitoneum, abdominal radiographs may reveal “the football sign,” which results from air outlining the abdominal cavity and surrounding the falciform ligament. Although most cases of pneumoperitoneum result from visceral perforation, there is increased awareness of other causes, resulting in an entity referred to as nonsurgical pneumoperitoneum (NSP). We report a case of nonsurgical pneumoperitoneum with a football sign on supine radiographs in a preterm 1-month-old infant who had a complex medical history. The patient developed sepsis and underwent an exploratory laparotomy, which ruled out perforation as well as any intra-abdominal cause for the pneumoperitoneum and infection.