Diagnosis: Ruptured Neonatal Appendicitis

the plain radiograph demonstrates the falsiform ligament (Figure 1) which is not normally seen. however, when there is gas in the abdomen, the liver is pushed back from both sides of the ligament. The resulting contrast makes the ligament evident.1 to confirm the impression of pneumoperitoneum, a second plain film of the abdomen was taken while the infant was held in an upright position. it clearly showed the accumulation of gas under the diaphragm (Figure 2). had the baby been very sick and if she could not be held upright, a cross-table or lateral decubitus x-ray film should have been taken. it would have shown a bubble of gas in the abdomen just under the umbilical stump. This approach is presently recommended so as not to disturb the patient.