Fig. 14

Perforated colonic carcinoma in a 70-year-old female patient presented with acute left hypochondrial pain and fever. a Focused coronal CT image showing asymmetric circumferential focal mural thickening involving splenic flexure and proximal descending colon with luminal narrowing “shouldering sign” (circle). b Coronal CT and c sagittal reformatted CT images showing infiltration of lower part of spleen with localized collection containing gas and fecal matter within the splenic substance, surrounded by hypodense splenic matrix (yellow arrow) with adjacent mild fat stranding (white arrow) and infiltration of the anterior aspect of the left renal parenchyma (curved arrow). d Axial CT (lung window) image showing free pneumoperitoneum (arrowhead), indicating perforation