Question: A 52-year-old woman presented to the emergency department with severe, diffuse abdominal pain of acute onset radiating to her left shoulder and neck. Her medical history was remarkable for cholecystitis and her surgical history was notable for laparoscopic cholecystectomy and C-section. On physical examination, she had diffuse tenderness and guarding. Her laboratory results showed a white count of 15,000/mm3, normal liver enzymes and a lactic acid of 2 mmol/L. A computed tomography scan of her abdomen (Figure A, B) showed free peritoneal air with lobulations around the gastric area and showed pelvic masses.