PMC3889000_01
An erect chest radiograph: No evidence of air beneath the diaphragm
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F1
An erect chest radiograph was normal with no evidence of subdiaphragmatic air [Figure 1].
Abdominal radiograph: Central, dilated loops of small bowel (white arrow). Note the plicae circulares or valvulae conniventes (yellow arrow), a feature of small bowel, which confirms that the dilated structure is small bowel. Some loops measure 64 mm in diameter. There is no gas within the large bowel suggesting a complete or nearly complete mechanical small bowel obstruction
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F2
Abdominal radiograph showed dilated small bowel loop in the central of abdomen [Figure 2].
Axial CT image of the upper abdomen: There is diffuse pneumobilia (black arrow)
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F3
CT examination of the abdomen and pelvis showed findings consistent with proximal small bowel obstruction, pneumobilia located in the right hepatic lobe [Figure 3], and a gallstone in the distal small bowel [Figure 4].
Axial CT image of the pelvis: There is a calculus (white arrow) identified within the small bowel lumen. Note the presence of both dilated and non-dilated small bowel
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F4
CT examination of the abdomen and pelvis showed findings consistent with proximal small bowel obstruction, pneumobilia located in the right hepatic lobe [Figure 3], and a gallstone in the distal small bowel [Figure 4].
Numerous gallstones retrieved from small bowel lumen
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F5
Numerous small bowel stones [Figure 5] of variable size were "milked" distally.
The largest gallstone measuring 3.5 cm in diameter
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F6
The largest stone measured 3.5 cm in diameter was retrieved from the small bowel lumen [Figure 6].