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This case report describes an acute colonic diverticular perforation occured to a multiple myeloma patient, taking corticosteroid and morphine therapy, revealed by a subcutaneous ephysema of upper chest and right abdomen as initial presentation. Sigmoid diverticulitis with perforation and generalized peritonitis is a severe complication of the diverticular disease and it is due to diverticular microperforation. This condition occurs more frequently in patients with widespread diverticolosis and usually after 50 years of age, and the frequency of related complications increases with age (and with the use of corticosteroids).