Colo-ovarian fistulization is a rare complication of serous adenocarcinoma of the ovary. This clinical case provides insight into its pathophysiological consequences and the best therapeutic approach in this unusual situation.

The main objective of this case report is to critically evaluate the difficulties associated with the diagnosis and treatment of a rare endogenous intestinal perforation, represented by an impacted gallbladder stone; thus increasing the awareness of jejunal perforation and small bowel diverticula.

Although sigmoidal diverticulitis is a prevalent medical-surgical condition, the clinician may be misled in his or her diagnosis due to the plethora of findings. We describe through this clinical case an isolated retropneumoperitoneum secondary to a sigmoiditis by detailing the reasoning behind our approach.