60 yo. male with PMHx of recurrent diverticulitis and PSHx of appendectomy for perforated appendicitis w c/o diffuse abdominal pain worse in the lower abdomen beginning Wed night. Pt states Tues night he ate a take-out meal and began to notice some abdominal cramping, then Wednesday morning experienced severe pain with nausea but no emesis. Pt has since remained NPO however his pain failed to improve which prompted the pt to request evaluation with facility provider. Pt denies fevers, night sweats, change in bowel habits, hemoptysis, hematemesis, constipation or diarrhea, Denies light stool, dark urine or evidence of jaundice. Denies any exacerbating or ameliorating factors. There are no constitutional or associated signs and symptoms other than those mentioned above Pt last underwent colonoscopy 5 yrs ago significant for benign polyps and diverticulosis. Due for repeat this year Pt seen at bedside, afebrile, VSS. Labs significant for mild leukocytosis WBC 11 with normal lactic acid 1.1. Imaging significant for large volume pneumoperitoneum with dilated loops of small bowel and concerns for possible sigmoid perforation