This is a 64 year old female with history of Crohn's disease and Schatzki's rings who presented to ED after undergoing EGD with esophageal dilation with Maloney Dilator for dysphagia and surveillance colonoscopy, with left upper quadrant pain, tachycardia and elevated WBC. Initial work up included chest x-ray that showed some subphrenic free air and non-contrast CT of chest and abdomen that showed some abdominal free fluid. Thoracic surgery was initially consulted who stated low chances of esophageal perforation due to lack of pneumomediastinum and no pleural effusions. Colorectal was then consulted. At that time oral contrasted CT abdomen showed increased free fluid but no gastric leak. Colorectal also stated low chances of this being colonic perforation. General surgery then consulted. Her abdominal exam had worsen and in comparison the amount of free fluid had increased in hours, for that reason patient was taken to OR for diagnostic laparoscopy. Patient was found to have a posterior wall stomach perforation. Stay sutures were placed and perforation was stapled off. Intra operative endoscopic leak test was negative. Drain left in place. Post operative UGI negative for leak on POD#2. Patient discharged on POD#3. On 2-week follow up patient had completely recovered.