Review Question - QID 210567

A 35-year-old woman is on the surgical floor status post abdominal hysterectomy for uterine fibroids and is post-operative day 4. The procedure was successfully performed without any complications or significant loss of blood. She was given prophylactic cefazolin prior to the procedure and ibuprofen as needed for pain. The patient cannot tolerate an oral diet, feels nauseated, and has episodes of emesis. She has mild diffuse abdominal pain and denies passing flatus or stool but is able to pass urine. Her temperature is 100.2°F (37.9°C), blood pressure is 140/100 mmHg, pulse is 98/min, respirations are 17/min. On physical exam, the lower abdominal incision is clean, dry, and intact. The abdomen is mildly distended with absent bowel sounds and is tympanic to percussion. An abdominal radiograph is shown in Figure A. Which of the following is the most likely cause of this patient’s symptoms?