A 69-year-old man with good past health complained of colicky abdominal pain, increasing abdominal distension, vomiting and constipation. On general examination he was afebrile, dehydrated and tachycardic.
Abdominal examination showed a distended abdomen with visible peristalsis, and there was generalized abdominal tenderness but no mass could be palpated. Auscultation revealed tinkling and accentuated bowel sounds. There was no abdominal scar to indicate previous surgery.
Laboratory investigations showed slightly elevated urea (probably related to dehydration) but were otherwise normal. A supine abdominal radiograph of this patient was performed.
What radiological abnormalities can you identify on this radiograph and what’s the diagnosis ?
