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A 64-year-old man is admitted with central epigastric pain.

Abdominal x ray shows a central dilated bowel loop. His temperature is 37.0°C, pulse 130 beats per min, blood pressure 80/50 mmHg, respiratory rate 29/min and SpO2 90 on air.

His full blood count reveals:

Haemoglobin 130 g/L (130-180)
White cell count 3.2 ×109/L (4-11)
Platelets 108 ×109/L (150-400)
MCV 105 fL (80-96)

Which of the following is the most likely diagnosis?

A.Gall stone ileus
B.Ischaemic bowel
C.Pancreatitis
D.Perforated duodenal ulcer
E.Small bowel obstruction

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