A 54-year-old man presents to the emergency department with a 4-day history of abdominal distension, central colicky abdominal pain, vomiting, and constipation. On further questioning, he says he has passed a small amount of flatus yesterday but none today. He has had a previous right-sided hemicolectomy 2 years ago for colonic carcinoma. He lives with his wife and has no known allergies. Examination: His blood pressure and temperature are normal. The pulse is irregularly irregular at 90/min.
He has obvious abdominal distension, but the abdomen is only mildly tender centrally. The hernial orifices are clear. There is no loin tenderness and the rectum is empty on digital examination. The bowel sounds are hyperactive and high pitched. Chest examination finds reduced air entry bibasally. An X-ray of the abdomen is performed (image attached) Investigations: Parameter Detected Normal…
