Creating blow-hole colostomy for decompression couldprovide a time-saving and efficient surgical procedure fora severely debilitated case with a completely obstructedcolorectal cancer.Complications are reported as prolapse,retraction,and paracolostomal abscess.However,complication with an ischemic distal limb has not beenreported.We report a case of critical intra-abdominaldisease after decompressed colostomy for relievingmalignant sigmoid colon obstruction;a potential fatalcondition should be alerted.A 76-year-old male visitedour emergency department for symptoms related toobstructed sigmoid colon tumor with foul-odor vomituscontaining fecal-like materials.An emergent blow-holecolostomy proximal to an obstructed sigmoid lesion wascreated,and resolution of complete colon obstructionwas pursued.Unfortunately,extensive abdominal painfuldistention with board-like abdomen and sudden onset ofhigh fever with leukocytopenia developed subsequently.Such surgical abdomen rendered a secondarylaparotomy with resection of the sigmoid tumor alongwith an ischemic colon segment located proximally upto the previously created colostomy.Eventually,thepatient had an uneventful postoperative hospital stay.In the present article,we have described an emergentcondition of sudden onset of distal limb ischemia afterblow-hole colostomy and concluded that despite the decompressed colostomy would resolve acute malignantcolon obstruction efficiently;impending ischemic bowelmay progress with a possible irreversible peritonitis.Any patient,who undergoes a decompressed colostomywithout resection of the obstructed lesion,should bemonitored with leukocyte count and abdominal conditionsurvey frequently. Creating blow-hole colostomy for decompression couldprovide a time-saving and efficient surgical procedure fora severely debilitated case with a completely obstructed colorectal cancer. Applications are reported as prolapse, retraction, and paracolostomal abscess. Host, complication with an ischemic distal limb has not been reported. We report a case of critical intra-abdominal disasease after decompressed colostomy for relieving malignant sigmoid colon obstruction; a potential fatal condition should be be alerted. A 76-year-old male visited emergency department for symptoms related to blocked sigmoid colon tumor with foul-odor vomituscontaining fecal-like materials.An emergent blow-holecolostomy proximal to an obstructed sigmoid lesion wascreated, and resolution of complete colon obstructionwas pursued.Unfortunately, extensive abdominal painfuldistention with board-like abdomen and sudden onset ofhigh fever with leukeocytopenia developed by using .Such surgical abdomen rendered a secondarylapa rotomy with resection of the sigmoid tumor along with an ischemic colon segment located proximally up to the previously created colostomy. Eventually, thepatient had an uneventful postoperative hospital stay. in the present article, we have described emergentcondition of sudden onset of distal limb ischemia afterblow-hole colostomy and concluded that despite the decompressed colostomy would would acute acute malignantcolon obstruction efficiently; impending ischemic bowelmay progress with a possible irreversible peritonitis. Any patient, who undergoes a decompressed colostomywithout resection of the obstructed lesion, should be monitored by leukocyte count and abdominal conditionsurvey frequently.