A 49-year-old man presented with a 24h history of low abdominal pain. There was no significant past history. He was focally tender in the lower abdomen with a WBC count of 16K. CT scan was obtained which showed an inflamed rectosigmoid with fat stranding consistent with acute diverticulitis. There was no evidence of abscess or free air.
Twenty-four hours after admission, the patient desaturated. Chest X-ray showed a large amount of free air under the diaphragms. He was taken urgently to the operating room for laparotomy.
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