The splenic flexure lesion is causing large bowel obstruction. The distribution and appearance of the gas in the cecum and ascending colon is not entirely typical of pneumatosis, particularly as it is not definitely circumferential, and may simply be due to gas trapped between the luminal stool content and the colonic mucosa. Nonetheless the differential is the presence of mucosal gas which may be indicate developing proximal colonic ischemia and should be communicated to the referring clinician. An extended right hemicolectomy confirmed an adenocarcinoma of the splenic flexure but no perforation.