Sudden onset severe abdominal pain. O/E Tender +++ with guarding and percussion tenderness ?peritonitis
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Fecolith in the mid sigmoid colon. Small defect on the anterior wall of the mid sigmoid with multiple blebs of adjacent pericolic free gas. Several small blebs of free gas track into the mesentery. No diverticula.
Small volume of free fluid in the pelvis and upper abdomen.
Not all sigmoid perforations are from a tumor or diverticular disease.