Spontaneous rupture of the stomach during the neonatal period is the most common type of nonobstructive perforation. The clinical manifestations include severe abdominal distension, vomiting, and respiratory distress. However, diagnosis is based on an upright x-ray film of the abdomen which shows the "saddle" of "football" sign due to massive pneumoperitoneum. The fatality rate is still quite high. Success in treatment depends on early diagnosis and immediate surgical intervention.