US is a useful and highly accurate tool to assess acute appendicitis in early childhood. US has the potential to aid in diagnosis of early childhood appendicitis to avoid the frequent rupture with tumor formation seen at this age. Initial conservative treatment for ruptured appendicitis with tumor formation is safe and is associated with a smoother postoperative course in early childhood.

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Key words intestinal pseudo-obstruction syndrome, pneumatosis intestinalis, pneumoperitoneum.Pneumoperitoneum is almost indicating a perforated abdominal viscus requiring urgent surgical intervention. Spontaneous or non-surgical pneumoperitoneum is a rare clinical condition. We describe an adolescent girl who was diagnosed as chronic intestinal pseudo-obstruction syndrome (CIPOS) presented with repeated episodes of pneumoperitoneum secondary to pneumatosis intestinalis. Case reportA 16-year-old female patient without any previous medical or surgical history was transferred to our hospital due to repeated episodes of abdominal distension for one year. Her other associated symptoms included dull periumbilical pain, non-bilious vomiting, occasionally diarrhea, secondary amenorrhea and bodyweight loss from 38 kilograms to 33 kilograms in one year (