A five-day-old male was admitted to Mt Hagen Hospital with a history of vomiting, fever and rapidly progressive abdominal distension of one-day duration. Urgent abdominal X-ray revealed pneumoperitoneum. Laparotomy revealed a malrotation of the intestine with jejunal perforation. The baby died postoperatively, 21 hours after admission. The importance of plain abdominal X-rays and reliance on 'classical' plain film radiographic signs is highlighted.