Abdominal films are often no longer obtained in the setting of acute abdominal pain, with most patients proceeding directly to CT. It is true that if the patient is unwell enough, plain films are unlikely to make a CT unnecessary. Even so, in this case, supine and abdominal films were sufficient to make the diagnosis. Although with the advance of cross-sectional imaging confidence in abdominal plain films has diminished, gallstone ileus remains a favorite case for oral exams.