A 43-year-old man complaining of abdominal nausea starting 15 days earlier and vomiting was admitted to our emergency department. The patient was affected by a severe obesity with a BMI of 55.5; there was also a history of diabetes and hypertension. The abdomen was distended, diffusely painful, tympanic to percussion and the Blumberg sign was intensely positive; WBC count was 24,000 x10 * 3 with marked neutrophilia, hemoglobin 9.6 g / dl, with haematocrit 30.6%. A distended colon was present at plain RX abdomen while the CT could not be performed due to the high BMI of the patient. At laparotomy a giant idiopathic megacolon was found and a Hartmann procedure was performed. The patient was discharged 15 postop with no complication. The anatomopathological examination documented a normal colon tissue. Diagnosis in obese patients is often difficult because they are paucisintomatic and the physical examination is difficult to achieve.

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Corresponding author
Pietro Fransvea, Faculty of Medicine and Psychology, "La Sapienza" University of Rome-St Andrea’s Hospital, Rome, Italy (pietro.fransvea@gmail.com)