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A healthy 65-year-old woman presents to the emergency room with a 12-hour history of sudden onset severe lower abdominal pain. This is her first episode. She reports nausea, vomiting, and anorexia. Her last colonoscopy was at age 60, and was normal, except for diverticulosis of the sigmoid colon. Physical examination is significant for fever, tachycardia, and generalized abdominal pain with rebound tenderness. Pertinent laboratory findings include a leukocytosis and metabolic acidosis. A computed tomography (CT) scan is obtained and is consistent with freely perforated diverticulitis, including a thickened sigmoid colon, free fluid in the pelvis and free air noted near the diaphragm (Figure 1). The surgeon completes the patient evaluation, recommends initiation of IV fluid resuscitation and antibiotics, and plans to go immediately to the operating room for surgical resection.