Pneumoperitoneum in neonates is not an uncommon condition. Free air in peritoneum may be secondary to host of pathological lesions. Usually the patient presents with signs of intraperitoneal sepsis, however presence of air in the scrotum as a concomitant sign is a rare event. Herein we report a 4-day-old neonate who presented with 2 days history of fever and scrotal swelling. Abdominal signs were subtle. Scrotum was hugely distended and tense. Workup of the patient revealed free intraperitoneal gas with air in the scrotum. At exploration, two perforations were found near the greater curvature of stomach and repaired. Post-operative course was uneventful.
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