The abdominal x-ray shows

Gall stone ileus. There are prominent central bowel loops with pneumobilia. There is no obvious gall stone visible in the small bowel but the findings should raise suspicion for small bowel obstruction from gall stone stuck in the distal ileum & as such a CT scan of the abdomen is warranted to confirm the diagnosis.

Gall stone ileus is identified on abdominal x-ray with following findings (Rigler’s triad)-

• Small bowel obstruction
• Pneumobilia
• Impacted gall stone at the distal ileum