A 90-year-old woman with a history of coronary disease and gallstones presents to the emergency department with generalized abdominal pain that started suddenly about 7 hours prior. It improved initially but then worsened a number of times. Currently, it is mild again. She has never had abdominal pain such as this before.

She denies any fever, vomiting, melena, bleeding, or diarrhea, but she said she does feel very bloated. She had a small bowel movement earlier today but then had a large bowel movement after the pain started.

Physical examination

Vital signs were normal except for a blood pressure of 161/98 mm Hg. The head and neck exam, as well as the cardiopulmonary exams, were normal. The abdomen was soft and nontender but distended. There was no rebound, guarding, or rigidity, but it was somewhat tympanitic.

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Diagnostic testing

  • Troponin undetectable
  • Metabolic panel was normal except for a sodium of 132 mEq/L and a glucose of 163 mg/dL. Liver function tests and amylase normal.
  • White blood cell count elevated at 11,000.
  • A KUB is shown below

What does the KUB show?

What should be your next step?

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