The transverse and right colon, and ileum are grossly distended. The cecum measures more than 10 cm in diameter on sagittal images. The left colon and rectum are collapsed. There is a transition point at a left diaphragmatic hernia (ostium 2 cm). The hernia contains a short segment of the splenic flexure that is distended with gas and fluid. The colon is thin-walled and there is no evidence or ischaemia/strangulation. There is some free intraperitoneal fluid, but no free intraperitoneal gas.