What is the most likely cause of abdominal pain in an elderly nursing home resident with abdominal distension and vomiting?

In the context of an elderly nursing home resident presenting with abdominal pain, distension, and vomiting, torsion of the sigmoid colon is particularly plausible. This condition, also known as sigmoid volvulus, occurs when the sigmoid colon twists on itself, leading to obstruction. In older individuals, especially those in nursing homes, factors such as decreased mobility, chronic constipation, and institutionalized living can contribute to the development of this condition. The symptoms of abdominal distension and vomiting align well with bowel obstruction, which would be expected in a case of volvulus.

Additionally, the age and overall health of the patient can predispose them to such events, as weaker connective tissues and peristalsis can lead to abnormal rotations of the bowel. In such scenarios, prompt diagnosis and surgical intervention are often required due to the risk of ischemia and perforation associated with torsion.

Considering the other potential causes, while acute appendicitis can present with abdominal pain, it is less common in the elderly and may not typically cause significant distension. Inflammatory bowel disease is generally seen in younger populations and involves more chronic symptoms rather than sudden presentations. Peptic ulcer disease can result in pain and certain gastrointestinal symptoms, but it would not usually lead to the distension and