A 71 year old lady presented to the accident and emergency department with a two-day history of severe abdominal pain. She had not opened her bowel for 24 hours which was unusual for her. She had past medical history of nissen's fundoplication for hiatus hernia and gastro oesophageal reflux disease. Unfortunately, she was sent home with diagnosis of constipation. She returned ten hours later with worsening of abdominal pain. On examination, she was drowsy, pyrexial and tachycardic. Abdomen was distended, tender on palpation with severe guarding and rigidity.

Abdominal X-ray was performed after initial resuscitation.
What is the most likely diagnosis?

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