Findings:
There is intrahepatic, and to a lesser degree, extrahepatic pneumobilia. The gallbladder forms a fistula with the first portion of the duodenum. There is a small bowel obstruction with transition in the left upper quadrant secondary to a mixed density material in the lumen of the bowel consistent with a gallstone. There is fat stranding surrounding the small bowel with small volume of fluid in the mesentery. These findings are consistent with gallstone ileus.
The esophagus is patulous and filled with debris. There is a subdiaphragmatic gastric tube with its tip in the body of the stomach.
There are scattered colonic diverticula without evidence of diverticulitis.

There is levoconvex rotoscoliosis of the thoracolumbar spine centered at L1.
There are postsurgical changes of posterior rod and screw fixation at L4-L5 with intervertebral disc spacer. In addition, there are postsurgical changes of sacral augmentation. Cement material is seen along the left lateral recess of the sacral spinal canal.

There is a mixed soft tissue density along the left iliopsoas muscle which is felt to represent a hematoma given the recent surgery. There are scattered foci of air throughout the left retroperitoneum and perinephric space. There are few foci about the descending colon which are felt to be in the retroperitoneum. These findings are likely
postoperative from recent back surgery. However, a superimposed infection cannot be excluded.
There is a 3 mm nonobstructing stone in the left inferior pole of the kidney. There is contrast overlying the bladder.
Moderate aortoiliac atherosclerosis mild narrowing at the ostium of SMA, celiac axis, and right renal artery. There is tortuosity of the nonaneurysmal abdominal aorta.

Impression:
Small bowel obstruction secondary to obstructing gallstone with pneumobilia. These findings are consistent with gallstone ileus.
There are postsurgical changes of L4-L5 fixation with a retroperitoneal hematoma and retroperitoneal focus of gas.

Bibasilar airspace opacities, likely representing aspiration considering the patulous esophagus.

Recommendations:
For your training purposes, recommendations are not included in this report.