Elderly Woman With Abdominal Pain and Distension

An 80-year-old woman with a history of hypothyroidism and cholecystectomy performed 4 months prior presented to the emergency department with a 2-day history of progressive abdominal pain and distention.Vital signs were significant for a blood pressure of 147/87 mmHg.Abdominal examination was remarkable for significant distention, tympany to percussion, and diffuse tenderness to palpation.The skin was warm and dry, negative for jaundice.Laboratory testing revealed hypokalemia.A bedside radiograph (Fig 1) and computed tomography scan (Figs 234) were obtained.The surgery team was consulted, and intravenous (IV) fentanyl was administered for analgesia prior to admission.