The first x-rays were misinterpreted in the ED as free abdominal air.
During subsequent laparascopy the surgeons couldn't find any site of perforation but did identify a distended loop of large bowel between the right lateral diaphragm and the liver. They sugested a stenosing process of the transverse colon.
The CT reveals, as the main finding, a caecal volvulus with the classic "whirl sign" and some distended, fluid filled small bowel loops with air-fluid levels, consistent with an obstructive small bowel ileus.
The free abdominal air on the CT is attributable to the recent laparascopy.
Incidental findings include: