89.A 55-year-old man presents to the ED complaining of mild diffuse
abdominal pain. He states that he underwent a routine colonoscopy yester-
day and was told “everything is fine.” The pain began upon waking up and
is associated with some nausea. He denies fever, vomiting, diarrhea, and rec-
tal bleeding. His BP is 143/71 mm Hg, HR is 87 beats per minute, tempera-
ture is 98.9°F, and RR is 16 breaths per minute. His abdomen is tense but
only mildly tender. You order baseline laboratory tests. His chest radiograph
is seen below. Which of the following is the most likely diagnosis?
86 Emergency Medicine
a. Ascending cholangitis
b. Acute pulmonary edema
c. Acute liver failure
d. Pancreatitis
e. Pneumoperitoneum