Diverticulitis is a significant contributor to the number of hospital admissions and healthcare costs in Western societies. The authors present the case of an otherwise healthy 33-year-old Hispanic male presenting to the emergency department with complaints of abdominal pain, pneumaturia, and hematochezia. The patient had no underlying risk factors, substantial prior medical history, or typical symptoms of diverticulitis. He was diagnosed with acute diverticulitis with a presumed colovesical fistula. The unique clinical presentation and the intraoperative findings are discussed. The objective of this case report is to make clinicians aware of atypical presentations of acute diverticulitis and guide the appropriate diagnostic workup for young Hispanic males presenting to the emergency departments with complaints of abdominal pain.