A patient presents with sudden onset of severe abdominal pain, vomiting and abdominal distension (bloating). Imaging reveals a twisting of the intestine that leads to obstruction and compromised blood flow. What is the most likely diagnosis? 

• A. Enterostenosis.
• B. Cholecystitis.
• C. Cirrhosis.
• D. Volvulus.

Answer: (D)

Verified step by step guidance

1. Step 1: Identify the key clinical features presented by the patient: sudden onset of severe abdominal pain, vomiting, and abdominal distension (bloating). These symptoms suggest an acute abdominal condition involving the gastrointestinal tract.
2. Step 2: Understand the imaging finding described: twisting of the intestine leading to obstruction and compromised blood flow. This is a critical clue indicating a mechanical problem causing blockage and ischemia.
3. Step 3: Review the definitions of the given options: enterostenosis refers to narrowing of the intestine, cholecystitis is inflammation of the gallbladder, and cirrhosis is chronic liver damage with scarring. None of these directly describe twisting of the intestine.
4. Step 4: Recognize that 'volvulus' is the medical term for twisting of a loop of intestine around its mesenteric attachment, causing obstruction and ischemia, which matches the clinical and imaging findings perfectly.
5. Step 5: Conclude that the most likely diagnosis based on the symptoms and imaging is volvulus, as it explains the sudden severe pain, vomiting, distension, and compromised blood flow due to intestinal twisting.