Most patients with colonic perforation present with a symptomatic abdomen. We described here, a 77-year-old woman who sustained a colonic perforation yet had a silent abdomen. A chest X-ray demonstrated pneumoperitoneum, pneumomediastinum and subcutaneous emphysema over the soft tissues of the bilateral neck and upper thorax. No fever, abdominal
tenderness or any peritoneal signs were found in the seemingly surgical condition. The management of the patient was non-operative. After conservative treatment and outpatient department follow-up, the woman had an uneventful recovery.