Man with severe abdominal pain

Clinical introduction

A 59-year-old man with no medical history presented to the ED with abdominal distension, vomiting and diffuse abdominal pain after drinking seven cups of white gourd drink (an authentic Asian drink composed mainly of white gourd). A chest radiograph was performed (figure 1).

Figure 1

Chest radiograph. AP, anteroposterior.

Question

What is the most likely diagnosis?

Crescent in doughnut sign, intussusception

Falciform ligament sign, pneumoperitoneum

Stepladder sign, small bowel obstruction

Coffee-bean sign, sigmoid colon volvulus

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