An 80 year old smoker with coronary artery disease s/p 2 vessel coronary artery bypass graft, hyperlipidemia, and congestive heart failure presents to the emergency department with rapid onset severe periumbilical abdominal pain, nausea, and vomiting. There is mild abdominal distension but no rebound, tenderness, or guarding. The patient's mental status is slightly worse than baseline. A rectal exam is positive for fecal occult blood. A CT is shown below.
Challenge: What's your diagnosis?
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