Spot the Diagnosis

A 73-year-old lady was admitted with abdominal pain, vomiting and significant weight loss. Her initial biochemical profiles were normal. Plain radiographs of the chest and abdomen were normal. An abdominal ultrasound scan revealed stones in the gallbladder as well as in the common bile duct. She underwent endoscopic retrograde cholangiopancreaticography (ERCP) with removal of duct stones. Three days later, she developed severe abdominal pain associated with abdominal distension and obstipation. The plain radiograph done at this stage is depicted as Figure 1. What is the Diagnosis?