Snap Shot A 41-year-old male with history of Crohns disease presents to the emergency departmentwith severe abdominal pain. The patient reports that he has not had a bowel movement in 24 hours. His pain continues to worsen. His abdomen is rigid and distended and he is experiencing nausea. Introduction Etiologies include: actute diverticulitis cancer inflammatory bowel disease ischemic bowel abdominal trauma Presentation Symptoms abdominal pain and rigidity Physical exam abdominal rigidity and rebound tenderness may exhibit "peritoneal signs" - extreme pain with any touch or movement Evaluation Upright Abdominal Radiograph free sub diaphragmatic air Treatment Nasogastric tube decompression IV fluids Antibiotics Immediate surgical resection required