Markedly dilated loops of small bowel, and a dilated transverse colon is seen on the chest x-ray. The chest x-ray is taken standing up (erect) and shows air-fluid levels in both the small and large bowel. On the abdominal x-ray, there is no gas seen in the large bowel beyond the splenic flexure. The upper abdominal x-ray shows an abrupt transition from distended to collapsed colon just beyond the splenic flexure (colonic cut-off sign). The findings indicate small and large bowel obstruction.
A CT of the chest, abdomen and pelvis should be the next step as the findings are suspicious for a colonic malignancy.