PMC8091627_01
Supine abdominal X-ray with high suspicion of free air under the diaphragm
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fig1
The patient could not tolerate standing for an upright chest X-ray, and a supine abdominal X-ray showed a suspicion of free air (Figure 1).
Intraoperative image of perforation controlled with bowel clamp
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fig2
ASA IV and taken to the operating room at high risk of death and perioperative complications. An emergency midline laparotomy was performed, which revealed fecal matter all over the abdomen and a 2-cm free perforation of the sigmoid colon in addition to multiple diverticula in which some of them were included in the tear (Figure 2).