The are multiple loops of dilated small bowel with small bowel feacalisation of the mid-small bowel. There is a large round laminated object located within the small bowel measuring 26 X 32 mm within the pelvis. It is likely to represent a low-density biliary calculus causing proximal obstruction with collapse of distal bowel loops. This is likely an underlying cholecystoduodenal fistula present.
There intrahepatic and extrahepatic bile duct dilation with no pancreatic head lesion or choledocholithiasis identified. There is a large gall bladder calculus measuring 23 mm in diameter. There is no evidence of gallbladder distension or signs of acute cholecystitis. There is sigmoid diverticulosis.