Rare cause of pneumoperitoneum: perforated appendicitis mimicking upper gastrointestinal perforation

Pneumoperitoneaum is seen in perforated hollow viscus but is a rare presentation in cases of perforated appendicitis. It accounts for 0-7% of patients with pneumoperitoneum. We report on a 24 year old male with epigastric pain for 4 days, demonstrating air under diaphragm on an erect chest X-ray. This case highlights that perforated appendicitis although rarely associated with pneumoperitoneum, must be considered in the differential diagnosis of patients presenting with acute abdomen.