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PCI typically follows a benign course and can be managed with physical examinations and imaging studies. In this case, however, the patient was comatose from a severe traumatic brain injury, rendering the physical examination unreliable. Abdominal CT revealed multiple extraluminal air foci in the retroperitoneal space surrounding the ascending colon, consistent with pneumoperitoneum. No evidence of intraoperative peritonitis was found. 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