A 26-Year-Old Man Is Brought to the Emergency Department Because

A 26-year-old man is brought to the emergency department because of abdominal pain, nausea, and vomiting for the past 1 hour. The patient has not had diarrhea or fever. Two hours ago, he ate a sandwich and coleslaw from a deli. He has no history of serious illness and takes no medications. He works as a computer scientist. He appears ill. His temperature is 37.6°C (99.6°F) , pulse is 80/min, and blood pressure is 122/68 mm Hg. Pulse oximetry on room air shows an oxygen saturation of 98%. Cardiac examination shows no abnormalities. The lungs are clear to auscultation. Abdominal examination shows diffuse mild tenderness with no rigidity, rebound, or guarding. Which of the following is the most likely cause of this patient's symptoms?

A) Bacterial exotoxin production in the gut
B) Bacterial invasion of the gut mucosa
C) Ingestion of preformed enterotoxin
D) Microbial attachment to the intestinal surface
E) Systemic absorption of luminal endotoxin