This 64 y/o male with a history of chronic abdominal pain complained of a recent increase in the crampy abdominal discomfort. On physical exam he demonstrated some abdominal tenderness without rebound. He was afebrile, WBC - 8,500 /cc³. Plain abdominal films followed by spiral abdomino-pelvic CT with rectal contrast were performed. Selected images from the abdomino-pelvic CT shown above demonstrate findings of a perforated giant sigmoid diverticulum. Surgical resection of the sigmoid and giant diverticulum was performed.

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