A case of recurrent abdominal distension

A 50-year old man with recurrent history of unable to pass stools for 3 days’ duration with abdominal distension. Otherwise he appears comfortable. On examination, abdomen is distended, but soft and non-tender on palpation. Bowel sounds were diminished. He had multiple admissions for similar complaints for the last two years. The abdominal x-ray for the current admission is as below:





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