Medical history A 68-year-old female patient attends to the emergency room complaining of abdominal pain and distension in the past 24 hours, together with multiple vomit episodes. At physical exam, is sudoretic, regular BP, distended abdomen, increased peristalsis, diffuse abdominal pain, but without apparent peritoneal irritation. Refers intestinal constipation, with the last bowel movement in 48 hours. In the past year, had multiple episodes of abdominal colicky pain, less intense than present, with spontaneous resolution. A computerized tomography was made. Image 1: Computerized tomography showing axial view of the upper abdomenImage 2: Computerized tomography showing axial view of the upper abdomenImage 3: Computerized tomography showing axial view of the mid abdomen Question:Based on the clinical picture and the CT findings, which of the following is the most likely diagnosis? Metastatic obstructive colon cancer Intestinal obstruction by foreign body Necrotizing acute pancreatitis Intestinal obstruction by gallstone Time is Up! Time's up
