Occult bowel perforation is a rare complication in chemotherapy of advanced epithelial ovarian cancer (EOC). The authors present a case of a 75-year-old woman who had appendectomy due to suppurative appendicitis five years prior, that experienced an occult bowel perforation resulting in continuous decline of electrolytes after a single cycle of nedaplatin (NDP) and paclitaxel during neoadjuvant treatment of advanced EOC. To the authors' knowledge, this is the first reported case of an occult bowel perforation after neoadjuvant chemotherapy (NAC) for ovarian cancer. The complication was highly suggestive of a cell lysis mechanism for the perforation.