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Perforated Diverticulitis: An Unexpected Twist in the Plot.

C cancer (CRC) is the most common gastrointestinal cancer and in early stages it may progress without any symptoms. Clinical symptoms may be discrete. Only approximately 15–30% of CRC patients present with symptoms of acute abdomen such as perforation, obstruction, lower gastrointestinal bleeding, or formation of an abscess [1]. These complications are common in the older population, typically in their sixth and seventh decade of life, while a worse prognosis is associated with their manifestation. CRC manifests without any symptoms in early stages or with non-specific clinical symptoms such as abdominal discomfort or change of bowel habits [2]. Perforation is the second most common reason for emergent surgery associated with colorectal carcinoma, with an incidence of 2.6–12% [3]. Intestinal perforation may be found either at the site of the tumor or on a more proximal site caused by distention of the bowel due to colonic obstruction. Diverticular disease is a common problem in western countries. Its prevalence increases with age, varying from approximately 5% in patients younger than 40 years and increasing to 50–66% in those older than 80 years [4]. The disease affects the sigmoid and descending colon in more than 90% of the patients. Diverticulitis may be uncomplicated, with bowel wall thickening and/or adjacent intra-abdominal fat stranding, or complicated, with the presence of bowel perforation with free intra-abdominal air, abscess, or fistula [5]. We present a case of colon cancer initially presumed to be complicated diverticulitis based on a computed tomography (CT) scan in a young patient.