As the surgeons entered into the abdominal cavity through a midline incision, the tissues in the left iliac fossa were significantly inflamed. The surgeon used his hand to mobilize the sigmoid colon and entered a cavity from which there was a “whoosh” of pus as indicated on the CT scan. The pus was washed out and drained. The sigmoid colon was remarkably thickened and inflamed and stuck to the dome of the bladder. Careful finger dissection revealed a small perforation in the dome of the bladder, allowing the passage of fecal material and gas into the bladder and producing the patient’s symptoms of pneumaturia and fecaluria. The sigmoid colon was resected. The rectal stump was oversewn and the descending colon was passed through the anterior abdominal wall to form a colostomy. The bladder was catheterized and the small hole in the dome of the bladder was oversewn.