Astute viewers will note the dilated large intestine on the scout, the free air in the retroperitoneum on the coronal reconstruction of the CT, and the liver metastases on the CT. Less apparent but visible is the obstructing lesion on the left of the bladder, most likely a sigmoid adenocarcinoma. Also visible on both images is the free air in the mediastinum.
All of which was unsuspected when the patient presented for abdominal pain and vomiting. That was an uncomfortable conversation, I can tell you. Very sad. The patient was admitted for comfort care.