Large hiatus hernia.
A grossly dilated loop of large bowel lies over the left side of the abdomen up to a diameter of 11cm with an air-fluid level extending up as high as the left upper quadrant subdiaphragmatic position. Possible beaked appearance to the right of midline in the central abdomen suggesting this is a point of transition/torsion.
Diffuse septated/loculated gas throughout the abdomen surrounding loops of small bowel. Occasional small locules of peritoneal gas, such as adjacent to the medial liver.
Pulmonary fibrosis with bilateral subpleural reticulation, ground-glass opacity and honeycombing. Associated traction bronchiectasis. Bilateral calcified pleural plaques.
IMPRESSION:
Caecal volvulus with diffuse small bowel and mesenteric pneumatosis cystoides intestinalis.