Pneumoscrotum as a presentation of necrotising enterocolitis
A preterm baby born at 32 weeks of gestation with a birth weight of 1.4 kg referred on day 11 of life with feed intolerance and scrotal swelling. Examination revealed slightly distended abdomen, absent bowel sounds and a huge scrotal swelling which was soft in consistency with shiny skin and brilliant transillumination.

Abdominal radiograph showed air under the right dome of the diaphragm and hugely distended scrotum with gas which was extending up to the inguinal canal. He was managed as a case of necrotising enterocolitis (NEC) with intravenous antibiotics, nil per oral, gastric aspiration and primary peritoneal drainage (peritoneal drain for 7 days).

There was an improvement in abdominal distension, feed intolerance and scrotal swelling; and resolution of air under the diaphragm, and pneumoscrotum. He was discharged after a hospital stay of 14 days.

Learning points
• Pneumoscrotum may be the sole obvious manifestation of bowel perforation in preterm neonates and is an important radiographic sign to aid in diagnosis.

• Every effort should be made to find out the site of air leak in a neonate presenting with pneumoscrotum.

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