High-grade small bowel obstruction with abrupt transition point in the midway though the small bowel in the pelvic midline. Distention of the stomach and proximal small bowel with air-fluid levels up to the transition point.
At the point of transition, there is a difficult-to-perceive oval, lamellated structure, consistent with a gallstone. Distally, the small bowel and colon are collapsed. Mild mesenteric edema.
Pneumobilia involving the common bile duct and left hepatic lobe. Relatively subtle cholecystenteric fistula with shrunken gallbladder containing small amount of air (see annotated coronal images).