Imaging Case of the Week 12

It is 3am and your next patient is a 70 year old female with abdominal pain and vomiting. To make things complicated, she also gives a history of runny stools. Her supine abdominal x-ray is as follows.

You are not too sure of what is going on and happen to notice your inpatient colleague sitting next to you and ask him for his opinion. He is not too impressed with the film and you are almost certain that he is going to refuse your referral. Would you refer this elderly patient with abdominal pain and vomiting to him anyway? What can you see on the x-ray?

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