Methods (differential diagnosis, investigations and treatment)
Laboratory values including white blood cell count, renal function and
lactate were within normal limits. CT scan of the abdomen and pelvis
showed pneumoperitoneum with a large amount of free air in the upper
abdomen, with associated mild ascites (Figure 1). No clear location of
ruptured viscus or inflammation was visible. There were also
fluid-filled distended loops of small bowel and massive distention of
the mid-transverse colon (Figure 2) and right colon (Figure 3)
containing air, stool and opaque material.