A 64-year-old man presents to the emergency department with abdominal pain and distention, as well as constipation of 8 days’ duration. He denies vomiting, fever, diarrhea, or dysuria. Except for hypertension, he is otherwise healthy with no prior surgeries.

His vital signs are normal except for a borderline pulse of 99 bpm. His physical examination is unremarkable except for his abdomen, which is large, rotund, and tympanitic. There is diffuse tenderness everywhere in the abdomen, but the left lower quadrant seems to be significantly more tender, and you think that you may feel a mass there.

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A plain film of the patient’s abdomen is shown below.

What does the image show? What should you do next?

Click to the next page for the answers.