A 65-year-old female patient with a history of colonic adenocarcinoma treated with surgery and concurrent radiotherapy four years ago. She presented to the emergency department with acute abdominal pain. Clinical examination revealed diffuse abdominal rigidity, suggesting a suspicion of peritonitis. An abdominopelvic CT scan (Figure 1) was performed, showing confluent abdominopelvic collections with enhanced walls after contrast injection, containing some air bubbles, along with peritoneal fat infiltration and moderate pelvic and perihepatic peritoneal fluid. Based on these clinical and radiological findings, the diagnosis of peritonitis secondary to bilateral tubo-ovarian abscess was established. The patient underwent an exploratory laparotomy, revealing a necrotic mass in the small intestine (Figure 2), with histopathological examination favoring a recurrence of colonic adenocarcinoma.