[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).