An 82 year old man develops severe abdominal distension, nausea, vomiting and colicky abdominal pain. He has not passes any gas or stool for the past 12 hours. He has a tympanitic abdomen with hyperactive bowel sounds. X-Ray shows distended loops of small and large bowel, and a very large gas shadow that is located in the right upper quadrant and tapers towards the left lower quadrant with the shape of a parrot's beak.
