[CASE HISTORY AND EXAMINATION]
A 49-year-old otherwise healthy gentleman presented to the emergency department with sudden-onset severe abdominal pain, nausea and vomiting. He had no history of fever, anorexia, weight loss, abdominal distension or jaundice. Vitals were stable. Per abdominal examination revealed localized tenderness, signs of peritonitis, prompting further investigations. Bowel sounds were heard and no additional observations were noted in the systemic examinations. On Laboratory investigations full blood count, renal function test, liver function test, serum amylase, lipase, PT-INR were all within normal limits.
Chest X-ray was done which showed the presence of free gas under the diaphragm suggestive of gastrointestinal perforation, necessitating emergency laparotomy. Bowel resection with anastomosis was performed and a significant finding was identified intraoperatively. A mobile mass, measuring approximately 10 by 10 centimeters in size, was discovered within the abdominal cavity which was situated 250 centimeters proximal to the ileocecal junction and was found to be covered by omentum (Figure 1).