Pneumoperitoneum is a rare complication of peritoneal dialysis, which in most cases occurs soon after the implantation of the peritoneal catheter and does not need any specific treatment. In contrast, pneumoperitoneum due to visceral perforation represents a serious clinical problem and usually needs an urgent surgical intervention. We present a case of a 10-year old girl treated by peritoneal dialysis for 7 months who was admitted to hospital with symptoms of peritonitis and pneumoperitoneum. On admission her condition was severe and visceral perforation was strongly suspected. As her parents did not give consent to surgical treatment, only conservative management was introduced. Peritoneal dialysis was continued and the girl responded well to antibacterial therapy. The final outcome was favourable.