Uterine perforation with acute abdomen as initial presentation of cervical cancer is an extremely rare condition. In this paper, we report a 76-year-old female patient who presented with acute abdomen with intra-abdominal free air. Hollow organ perforation was the initial diagnosis but a FIGO stage IIIb cervical cancer with pyometra and uterine perforation was later discovered after laparoscopic operation. She received concurrent chemo-radiation after operation and recovered well after therapy.