Perforated sigmoid colonic adenocarcinoma
Known disseminated sigmoid colonic adenocarcinoma. Now severe abdominal pain.
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Widespread metastases involving the lung, liver and peritoneum. Circumferential mass in the distal sigmoid with a defect containing gas, together with free peritoneal gas.
Bowel perforation associated with colonic cancer is usually due to bowel obstruction with proximal dilatation and rupture. It is highly unusual to see the cancer itself perforate with leak of gas into the peritoneum. Prognosis is usually poor.