This patient has findings of small bowel obstruction, with markedly dilated small bowel loops filling most of the abdomen, and if there were evidence of pneumoperitoneum, that would be a surgical emergency indicating perforation. You can tell that these are small bowel loops by their smooth outer margin and the close, evenly spaced folds, as well as the back-and-forth stacking of loops, which is only seen in the small intestine.

The blue button links to the ACR recommendations for evaluation of small bowel obstruction.