Abstract:  A 43-year-old woman pre-sented to the emergency department complaining of severe abdominal pain, nau-sea, and vomiting which awakened her from sleep 2 hours earlier. Physical exami-nation showed a diffusely tender, distended, tympanic abdomen with decreased bowel sounds. Laboratory test results were within nor-mal limits. The patient's med-ical history was significant only for a cesarean section 7 years previously. Conven-tional radiographs of the chest and abdomen were obtained. A computed tomo-graphic scan and barium enema were performed, fol-lowed by laparotomy.