Bowel obstruction practice

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Gastroenterology and Hepatologycommon

A 79-year-old woman presents with four days of intermittent cramping abdominal pain, vomiting and increasing abdominal distension. She has no history of abdominal surgery and has passed only a small amount of stool. CT shows dilated small-bowel loops, gas within the biliary tree and a calcified object obstructing the distal ileum. Which one of the following is the most likely diagnosis?