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Figure 1 CT demonstrating a large rectal tumour (A) with gross evasion of the perianal tissues, extension into the vagina and subcutaneous tissue bilaterally and a large volume of air in the tissues (B).

DESCRIPTIONA 76-year-old man presented with right upper quadrant (RUQ) swelling ( fi gure 1A ). He required endoscopic retrograde cholangiopancreatography with sphincterotomy 6 months earlier but declined cholecystectomy. CT demonstrated a large gallstone protruding through the abdominal wall ( fi gure 2B

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