<prompt> A very old lady, air in biliary tree, colicky abdominal pain with distension and hyper peristaltic abdominal sounds diagnosisGall stone ileusHemobiliaCholangitisPneumobilia  <response>: Ans. a Gall stone ileusRef: Sabiston 20th edition Page 1506 This is due to Cholecysto duodenal fistula which results in Pneumobilia and Obstruction 