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Gallstone ileus

Case contributed by Dalia Ibrahim
Diagnosis almost certain

Presentation

Abdominal pain and vomiting.

Patient Data

Age: 80 years
Gender: Female
ct

Multiple dilated small bowel loops showing multiple air-fluid levels, down to a transition point at the pelvic ileal bowel loop showing large intraluminal faintly radiodense stone, the distal bowel loops are collapsed distal to the stone.

Pneumobilia is noted (Gas within the common bile duct)

Annotated image

Rigler triad consists of three findings seen in gallstone ileus:

  • pneumobilia
  • small bowel obstruction
  • gallstone, usually in the right iliac fossa

Case Discussion

Care must be taken in finding the gallstone, as only a minority (12.5%) are calcified, and density may be very similar to bowel content !!!

Rigler triad consists of three findings seen in gallstone ileus:

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