The patient’s name is Long tai shun, 59 years old, male, who was operated for intestinal adhesions. He was born in Shehong, Sichuan, and underwent local appendectomy for acute suppurative appendicitis in 2003. After the operation, the patient has been suffering from intermittent lower abdominal and periumbilical distension. On examination, the patient was in good general condition, only somewhat wasted. On the day of admission, I performed a pneumoperitoneogram with a flat abdomen and left lower abdominal puncture, and everything went well. The pneumoperitoneum CT showed complete adhesion closure of the suprahepatic space and no spanning structures in the pneumoperitoneum space, so it was determined that there were no adhesions in the abdominal wall. The 3D plan view saw the fatty drape of the abdominal wall and did not think much of it. The left and right lateral scans were also done and analyzed carefully for a long time, but there was no clear picture. The patient’s family was informed of his condition as usual. When the patient requested to continue the laparoscopic surgery, he did not pay much attention to it. I thought it would be an exploratory and quick procedure. Things seemed to go smoothly, with the umbilical puncture and gas injection to establish a rising abdomen, placement of the laparoscope, and an operating hole up and down the left side. I went in and looked around for half a day and couldn’t figure out what was going on. The transverse colon was like a wall, and the omentum closed the upper abdomen completely. And no abdominal wall adhesions were seen in the middle and lower abdomen. The distal end of the small intestine had a few lateral posterior wall adhesions, while the proximal end had mesenteric adhesions of the intestine, and the inverted intestine had kind of a slightly smaller space, and the intestinal collaterals were twisted and could not be reset naturally, and there was a risk of intestinal torsion after surgery. I searched hard around the transverse colon in the upper abdomen and did not find the beginning of the adhesions, which was incredible. I wanted to forcefully detach the large omentum connected to the transverse colon and enter the upper abdomen to see what was going on, but I felt that it was not a normal separation of adhesions and there was a risk of accidental trauma, so it was not cost-effective. However, if I backed out of the procedure without understanding it, I would not have to take the risk, but it would be a shame to my own record, and I would not feel comfortable. I was anxious and in a dilemma, and the fat hanging from the abdominal wall often affected my vision and disturbed me. Suddenly I realized that it could be omental tissue and not abdominal wall fat dangling. It might be a full adhesion of the omentum and abdominal wall, and the umbilical laparoscope would simply not be able to see the condition of my own heel. For this reason, I quickly inserted a 10 mm Trocar in the suprapubic area and moved the laparoscopic viewing hole to the lower abdomen, and sure enough, the greater omentum and the anterior abdominal wall were spreading against each other like a ceiling. I carefully peeled the greater omentum from the abdominal wall to the level of the transverse colon. The laparoscope was then adjusted back to the umbilicus and the transverse colonic omentum was completely released from the abdominal wall. It was at this point that the patient’s true face was revealed. The liver, gallbladder, stomach, and other epigastric organs were only then revealed. This is the first case of misdiagnosis after pneumoperitoneography, which was not even detected by laparoscopy for a long time. The reason for this is still an empirical mistake, having previously been exposed to only some of the omental abdominal wall adhesions. In this case, due to the small and thin omental fat, the whole omental anterior abdominal wall adhesions were mistaken for peritoneal tissue microscopically, and the pneumoperitoneography was even more confusing. Afterwards, I carefully studied the pneumoperitoneography images again, and the virtual 3D laparoscopy was also shown, but the inertia in my mind blinded me to it. Figure 1: Virtual laparoscopy showing total adhesions of the omental abdominal wall Figure 2: Omental and anterior abdominal wall adhesions seen during laparoscopy Figure 3: Transverse colon like a wall blocking the upper abdomen.