A sixty-seven year old man on chronic high-dose narcotics with subacute onset of constipation and bloating presents with abrupt onset of severe pain, which is poorly localized and comes in waves. He reports no bowel movements in six days, and is uncertain whether he is passing flatus. There is no vomiting. Vital signs are normal, and exam shows a protuberant abdomen, tense and minimally tender to palpation, with normal bowel tones. Rectal exam shows an empty vault.
What does this abdominal x-ray show? What are the most common causes of this condition?
What is the indicated finding on this CT, and what is the likely diagnosis?
Put your answers in the comments. As usual, Vijay is ineligible, and the first correct answer will win my everlasting respect.