Acute abdomen is an important issue for physicians to timely intervention. The early diagnosis and treatment can significantly improve the mobility and mortality. The etiology of acute abdominal sign was reported in previous studies, such as abdominal aortic dissection, abdominal aortic aneurysm rupture, and hollow organ perforation. The typical symptoms were severe abdominal pain, cold sweating, and cannot be improved by pain killer. In some atypical patients, the acute abdominal sign is difficult for physician to find. Here, we present a case of a 69-year-old male who presented with acute onset progressive abdominal cramping pain, fever and chills, cough and dysuria. The physical examination revealed hypoactive bowel sound, periumbilical tenderness, and coarse breath sound. The multiple infection was suspected: pneumonia, urinary tract infection, and intra-abdminal infection. Computed tomography of abdomen revealed local fat stranding and suspected acute sigmoid diverticulitis. After surgical intervention, the abnormal colon tissue with mild local infection and perforation was found. The pathology report showed sigmoid adenocarcinoma. He discharged and followed up at outpatient department. This paper describes the clinical and image features of hollow organ perforation and highlights the early diagnosis and timely treatment for avoiding a potentially devastating outcome.

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