The Radiologist

Patient presented will abdominal dispensing and pain for 2 days
He has history of not fully passing stool for last 10 days despite suppositories and enemas.
His ultrasound of abdomen shows extensive gas shadows o scuring his liver and right kidney.
So now this is his xray erect abdomen.
Tell the findings, signs and next step in management?

Describe with differentials

Very subtle findings