Atypical image of pneumoperitoneum secondary to colon perforation

Abstract

66-year-old female with a diagnosis of bilateral ovarian carcinoma with peritoneal carcinomatosis and liver metastases, who only had one cycle of chemotherapy, she could not be given other cycles because the side effects caused poor general condition. She was admitted due to intermittent vomiting developing for a week and severe heartburn, with the last stool two days before, presenting abdominal distension and lower abdominal pain, without signs of peritonism and without peristaltic sounds. After performing several complementary tests, the computed tomography scan showed a large amount of intra-abdominal air, it was thought to be a possible transverse colon volvulus, which caused extrinsic compression on the stomach. A colonoscopy was performed to try to devolvulate, without success, which led to the performance of laparotomy, with exit of pneumoperitoneum when opening the abdominal cavity, which was blocked by peritoneal carcinomatosis, observing a perforation of the colon at the splenic angle.