A 43-year-old man with a prior history of an open appendectomy for perforated appendicitis presents with vomiting, abdominal pain, and distension. He reports he felt well until the day prior to presentation, when he developed diffuse abdominal cramping and nausea. The pain kept him awake overnight, and today he has had several episodes of non-bloody, bilious emesis. He has had no bowel movement in two days and cannot recall the last time he has passed flatus.
Upon examination, he appears uncomfortable, but has normal vital signs. His abdomen is distended and tympanitic, and diffusely tender to palpation, but without rebound or guarding. An upright abdominal plain film is obtained, and appears below.
Which of the following is the most likely diagnosis?
This question appears in Med-Challenger Emergency Nurse Practitioner Exam Review with CME
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