In a large pot, heat over medium heat and add the Italian sausage. Cook for about 5–7 minutes, breaking it apart with a wooden spoon, until it’s browned and cooked through. The sausage should reach an internal temperature of 160°F. Once ready, drain any excess fat, leaving just a bit for flavor.

Add the chopped onion and minced garlic to the pot with the sausage. Sauté for 3–5 minutes, stirring occasionally, until the onion becomes translucent and fragrant.

Stir in the canned tomatoes and heavy cream, mixing well to combine all the flavors. Add the fresh basil, oregano, and red chili flakes. Bring this mixture to a gentle simmer over medium heat, letting it bubble gently for about 5 minutes as the sauce thickens.

Add the rigatoni directly into the simmering sauce, ensuring the pasta is fully submerged. Cover the pot and let it simmer on low heat for 10–12 minutes, stirring occasionally.

Once the pasta is cooked, remove the pot from the heat and stir in the grated Parmesan cheese. Mix until the cheese melts completely into the sauce.

Spoon the Creamy Italian Sausage Rigatoni into bowls, garnishing with additional fresh basil and a drizzle of olive oil if you like. Serve hot.