Nausea, Vomiting, and Worsening Pain

A 75-year-old woman presents to the emergency department with a three-day history of abdominal pain. She does not recall eating anything unusual. She reports having nausea and vomiting and states that her pain is progressively worsening. Her medical history is significant for hypertension. Surgical history is significant for previous cholecystectomy and total abdominal hysterectomy. She is afebrile, and her vital signs are within normal limits. Her abdomen is soft and diffusely tender, with slightly decreased bowel sounds. No rebound or guarding is present. The rest of her physical examination overall is within normal limits. During the exam, she experiences a couple episodes of bilious vomiting. You order some laboratory studies as well as an abdominal radiograph (shown). What is your impression?