Accurate and timely detection of a perforated hollow viscus is crucial and has profound consequences for the patient with an acute abdomen. While a CT scan can provide an accurate diagnosis, the increasingly indiscriminate use of this modality sparks concern regarding radiation dosing, its associated safety concerns and its timely occurrence. There are distinct and readily reproducible findings of pneumoperitoneum on ultrasound. However, sonographers should be trained to detect pneumoperitoneum or patients may be discharged with false-negative results. This case report supports such a view and investigates the current literature surrounding this issue.