Presentation
24+1 weeks gestation. 1 week old. Increasing oxygen requirement.
Patient Data

ETT, NGT, UAC and UVC with positions appropriate (UVC slightly low).
Background granular appearance of both lungs consistent with RDS.
Large volume pneumoperitoneum outlining the falciform ligament: the football sign.

Confirmation of large volume pnuemoperitoneum.
Multiple loops of gas-filled bowel. Mural gas within left-sided bowel loops. Appearances of necrotizing enterocolitis.
Case Discussion
Necrotizing enterocolitis (NEC) complicated by perforation with a large volume of gas in the peritoneal cavity. Neonatal pneumoperitoneum is most commonly seen in NEC and is often seen in preterm babies who have respiratory distress syndrome.