This 68 y/o female presented to the ER with acute onset of left sided abdominal pain. Selected images from her abdominal CT scan shown above demonstrate diffuse thickening of the left colonic wall with some surrounding inflammatory changes. Diverticula are not seen. Ischemia and inflammatory bowel disease were considered in the differential diagnosis. A worsening clinical picture, with increasing peritoneal symptoms led to resection of her ischemic left colon.