1) Most likely diagnosis: and why: Small‑bowel obstruction (SBO). The image shows multiple centrally located, dilated small‑bowel loops with mixed fluid and gas and a relatively decompressed distal colon — a classic pattern for SBO. The absence of an obvious intraluminal mass on this slice and the central small‑bowel distribution make adhesive obstruction or an internal hernia/strangulated adhesive band most likely causes in the appropriate clinical setting. 2) Next best diagnostic step: Careful review of the full contrast‑enhanced CT dataset with multiplanar reformats to identify a transition point and to look for CT signs of ischemia/strangulation (bowel wall thickening, reduced enhancement, mesenteric edema, free fluid, pneumatosis). If the initial CT is noncontrast or nondiagnostic for transition, consider water‑soluble oral contrast small‑bowel follow‑through or CT enterography and obtain surgical consultation promptly. 3) Key differential: or confirmatory test: Differentials include ileus/pseudo‑obstruction, closed‑loop obstruction (internal hernia or volvulus), intussusception, or an obstructing mass/stricture (eg, Crohn’s, tumor). Confirmatory testing depends on the question: contrast‑enhanced CT enterography or small‑bowel follow‑through can confirm level and cause; diagnostic laparoscopy/laparotomy is both diagnostic and therapeutic when ischemia or an uncertain cause is suspected. 4) Possible treatment: or management: Initial management: resuscitate with IV fluids, correct electrolytes, keep NPO, place NG tube for decompression if vomiting or marked distension, analgesia and antiemetics, and urgent surgical consultation. If no signs of ischemia or peritonitis, a trial of conservative management (