Pneumoperitoneum almost always indicates a perforation. However, perforation is not detected approximately 5% to 15% of all exploratory laparotomies and it is called spontaneous pneumoperitoneum (SP). One of the rare causes of SP is Pneumatosis cystoides intestinalis (PCI). An 11-year-old female patient was transferred to the pediatric emergency department due to suspicion of intestinal perforation. Erect abdominal X-ray revealed pneumoperitoneum below the right diaphragm. Emergent exploratory laparotomy was performed. No perforation was detected during exploratory laparotomy. Both the absence of fever, peritoneal irritation signs and normal biochemical parameters SP must be considered. It should be kept in mind that PCI induced by constipation may be a cause of SP.

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The most common surgical emergency in the paediatric group during the coronavirus disease-2019 (COVID-19) pandemic is appendicitis, as it was before. This study aimed to evaluate clinical differences of paediatric appendicitis cases and changes in the management strategy between the pandemic and non-pandemic period.Methods: Cases during the non-pandemic period (March-July 2019) and pandemic period (March-July 2020) were analysed. Demographic data, duration of symptoms, physical examination, laboratory and radiological findings, paediatric appendicitis score (PAS), operative techniques, medical treatment, complications and hospital stay were evaluated retrospectively.Results: This study enrolled 70 patients during the non-pandemic period and 48 patients during the pandemic period. Duration of symptoms was significantly prolonged (p<0.001) and PAS was significantly increased during the pandemic period (p=0.001). Abdominopelvic ultrasonography detected abscess formation in one (1.4%) patient and 10 (20.8%) patients during the non-pandemic period and pandemic period, respectively. Complicated appendicitis was significantly higher (p=0.025) and the hospital stay were significantly longer during the pandemic period (p=0.017). Conclusion:During the COVID-19 pandemic, fewer patients presented to the paediatric emergency department with suspected appendicitis. Complicated appendicitis cases and hospital stay increased during the same period. The COVID-19 pandemic caused some changes in our approach to paediatric appendicitis cases such as the effective use of personal protective equipment, PAS scoring system and abdominopelvic ultrasonography.