Seen in the ED: Worsening Abdominal Pain, Distention in an Older Woman

Constipation, bloating, and abdominal pain worsening over 1 week bring a woman in her mid-70s to the ED. Labs are normal. What do you see on the CT scan?

History of present illness. A woman in her mid-70s with a history of chronic back pain and presents to the hospital with constipation, bloating, and abdominal pain that has gradually worsened over the past week. She denies any fever or vomiting. The pain is generalized, radiates to the chest, and comes in waves. Currently she is prescribed opioids and quetiapine.

Vital signs & physical examination. Vital signs are normal. Physical exam is also normal except for a tympanitic distended abdomen in an otherwise very thin woman.

Initial diagnostic testing

CBC: normal
: normal
Troponin & LFTs
: normal
: See CT

What is the most likely diagnosis?

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