Abstract
Hollow organ perforation is a serious and common abdominal emergency. The diagnosis depends on history taking, physical examination, and radiological fi ndings. We reported a hollow organ perforation patient with only indirect radiological signs of the heterogenous enhanced lesion between the stomach, duodenum, and liver over initial abdominal computed tomography. Pneumoperitoneum occurred in follow-up chest X-ray 5 hours after the emergency department visit. The reason for the delayed occurrence of pneumoperitoneum, direct/indirect radiological signs of hollow organ perforation, and ways to avoid this pitfall are discussed.