Idiopathic pneumoperitoneum in infants: A management dilemma and a literature review.

Idiopathic pneumoperitoneum is a rare, benign condition that mimics gastrointestinal perforation on radiographic imaging. Differentiating between medical and surgical pneumoperitoneum is challenging but crucial. We report a case of a 3-month-old boy who presented with massive pneumoperitoneum. The X-ray showed the pathognomonic "football sign." Idiopathic pneumoperitoneum was not initially considered, leading to surgical intervention. Spontaneous idiopathic pneumoperitoneum is rare beyond the neonatal period. Awareness of this condition, especially in specific scenarios such as mechanical ventilation or concurrent pneumothorax/pneumomediastinum, should be raised to avoid unnecessary and potentially risky surgery.