A 22-year-old female presented with 24 hours of acute onset, diffuse, non-radiating, abdominal pain. In addition, she reported 3 episodes of yellowish vomiting since the pain began, as well as obstipation.

Examination

On physical examination, abdominal bloating, hypoactive bowel sound, as well as generalized tenderness to palpation was noted significantyl. No masses were appreciated and Dance&rsquo;s sign was not observed. Digital rectal examination was negative with an empty rectum. Vital signs on arrival were as follows: pulse 88 beats per minute; saturation 100%; temperature 36.5&deg;C; blood pressure 140/70 mm Hg. Blood samples drawn in the Emergency Department showed mildly elevated white blood cells. An abdominal CT scan revealed severe gastric distention associated with a severe distention of the jejunum and ileum. Distention was noted up to the height of the right iliac fossa where a small bowel in small bowel invagination was visualized.