You are correct. The patient excreted a necrotic, full-thickness colonic cast. Histologic exam revealed all layers of the bowel wall. Passage of a colonic cast as a result of colonic hypoperfusion is rare and is characterized by the absence of peritonitis. In this patient, colonoscopy revealed a stricture with ischemic-appearing granular mucosa. She was initially treated conservatively, but ultimately underwent resection of the necrotic portion of the left-sided colon with definitive colostomy; she eventually recovered fully.