Supplementary Material for: Metastatic Colonic Adenocarcinoma Mimicking Acute Bowel Perforation: Hiccups and Vomiting as Unusual Initial Symptoms: A Case Report

Colonic adenocarcinoma commonly presents with altered bowel habits, abdominal pain, and weight loss. Intestinal perforations, a severe complication of colorectal cancer, have high mortality rates. This case report describes a 50-year-old man with rectosigmoid adenocarcinoma treated with chemo-radiotherapy who presented with intractable hiccups, watery diarrhea, and non-projectile vomiting. Initial imaging revealed a large intestinal perforation, ischemic colitis, and a stenosing rectosigmoid tumor. Due to the complex nature of his condition, a total colectomy with end ileostomy was performed. This case underscores the need for early recognition of atypical presentations of metastatic colonic adenocarcinoma and highlights the importance of a thorough diagnostic approach for timely management.