Pneumoperitoneum is a common presentation in surgical practice which is taken to be pathognomonic of hollow viscus perforation. Other lesions may also present as pneumoperitoneum. We present a case where a lady presented with upper abdominal pain of 5 days duration and vomiting. CT abdomen showed pneumoperitoneum with a ruptured left lobe liver abscess. Patient was taken up for laparotomy and lavage. Patient recovered well after surgery. This is a rare presentation and is one of the causes that should be considered. Early surgical intervention is mandated.