A 70-year-old woman, having had an appendectomy 25 years ago, is brought to the emergency room for severe abdominal pain. The patient describes this pain as crampy and colicky. She also admits that the pain seems to increase and then improve spontaneously. She has already vomited 5 times since the pain started in the morning. She had no bowel movement or flatulence for the last two days. Physical examination shows slightly distended abdomen with diffuse tenderness. Auscultation of the abdomen shows peristaltic rushes and high-pitched bowel sounds. Tympanic abdomen is revealed during percussion. Rectal examination also shows absence of stool.
What is the most likely diagnosis?
A- Intestinal obstruction