Rigler sign (bowel)

Last revised by Dr Ayla Al Kabbani on 20 Jan 2020

The Rigler sign, also known as the double-wall sign, is a sign of pneumoperitoneum seen on an abdominal radiograph when gas is outlining both sides of the bowel wall, i.e. gas within the bowel's lumen and gas within the peritoneal cavity. It is seen with large amounts of pneumoperitoneum (>1000 mL).

Pneumoperitoneum may be a result of perforation or, recent instrumentation or surgery. A false double-wall sign can result from two loops of bowel being in contact with one another, thus the wall thickness is double that of a single loop.

Rigler sign should not be confused with the Rigler triad, the Rigler notch sign, or Hoffman-Rigler sign.

It is named after Leo George Rigler (1896-1979), American radiologist 2.

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Cases and figures

  • Case 1: annotated
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  • Case 8: perforated Crohn disease of small bowel
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  • Case 10: on CXR
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