The provided case involves a 60-year-old obese female who presents with symptoms that include abdominal pain, distension, and increased bowel sounds. The presence of multiple air fluid levels and air in the biliary tree, along with a history of hysterectomy 2 years prior, helps narrow down the differential diagnosis.
To analyze the symptoms and imaging findings:
The options provided are:
Given the combination of symptoms and radiological findings, the presence of pneumobilia and air-fluid levels is particularly telling. Gallstone ileus is a condition where a gallstone enters the intestinal tract through a biliary-enteric fistula, usually leading to small bowel obstruction. This scenario aligns closely with the patient's presentation. Therefore, the most probable diagnosis is Gallstone Ileus.
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