An 87-year-old woman had acute onset of lower abdominal pain following a painful bowel movement. She had a history of diverticulitis and chronic constipation. Her medical and surgical history also included a remote history of renal cell cancer status after left nephrectomy, a hysterectomy, and steroid-dependent arthritis. On physical examination, she was afebrile and normotensive, but in moderate distress with lower abdominal tenderness and guarding. Abdominal computed tomography was performed (Figure 1and Figure 2).