Review Question - QID 109606

A 57-year-old man presents to the emergency department with epigastric pain. The patient states that he was at home watching television when his symptoms began. Otherwise, the patient has no complaints. The patient has a past medical history of obesity, hypertension, alcohol abuse, diabetes, and constipation. His current medications include insulin, metformin, lisinopril, and sodium docusate. His temperature is 99.5°F (37.5°C), blood pressure is 160/95 mmHg, pulse is 90/min, respirations are 14/min, and oxygen saturation is 98% on room air. Laboratory values and abdominal ultrasound are ordered and are currently pending. An abdominal radiograph is ordered as seen in Figure A. On physical exam, the patient is clinically intoxicated. A cardiopulmonary exam is within normal limits. The patient is started on IV fluids and given morphine. Which of the following is the most likely diagnosis?