Approach to postoperative abdominal pain Quiz: Ace Your Exams

A 65-year-old man presents to the emergency department for evaluation of worsening abdominal pain. Five days ago the patient underwent open partial colectomy with anastomosis to treat colonic adenocarcinoma. The patient has a history of hypertension, diabetes mellitus, and ulcerative colitis. At home, the patient has been experiencing nausea, vomiting, and subjective fevers. The patient is passing gas and had a bowel movement yesterday. Temperature is 38.9 °C (102.0 °F), pulse is 126/min, blood pressure is 95/65 mmHg, respirations are 18/min, and SpO2 is 96% on room air. On physical examination, the patient appears uncomfortable. The abdomen is distended and rigid with rebound, tenderness, and guarding. General surgery is consulted and laboratory studies are obtained and pending. CT of the abdomen and pelvis with IV and oral contrast is performed. Which of the following findings is most likely to be seen on abdominal imaging?