Rigler triad

Seen in – Gallstone ileus

What is Gallstone ileus?

Gallstone ileus, a rare complication of cholelithiasis, is caused by intestinal impaction of a gallstone that has migrated through a cholecystoenteric fistula.

In gallstone ileus is caused by passage of gallstones into the lumen by fistula formation. Which is the most common site of entry by erosion ?

A. Duodenum

B. Jejunum

C. Ileum

D. Caecum

Most frequently gallstones become impacted in which of the following site?

A. duodenum

B. Proximal ileum

C. Jejunum

D. Terminal Ileum

Gallstone ileus is responsible for ——- % of small bowel obstruction in patients over 65 years of age.

A. 5 %

B. 15 %

C. 25 %

D. 35 %

Rigler triad consists of three findings

  1. pneumobilia – air in the bile ducts
  2. small bowel obstruction
  3. ectopic calcified gallstone – gallstone outside the gallbladder- usually in the right iliac fossa

Pneumobilia is also called as – aerobilia

Case courtesy of Ian Bickle, Radiopaedia.org. From the case rID: 86930

Gallstone ileus

  1. It is a cause of mechanical small bowel obstruction.
  2. Rare complication of chronic cholecystitis
  3. Occurs when a gallstone passes through a fistula between the gallbladder and small bowel before becoming impacted at the ileocecal valve.

Repeated bouts of cholecystitis result in adhesion of the gallbladder to the small bowel (usually duodenum) with eventual fistula formation and passage of gallstones into the lumen. The most common site of entry by erosion is thought to be to the duodenum.

What is the Mortality of Gallstone ileus ?

Mortality is high -up to 22.7%

What is ‘Rigler sign’?

Rigler triad is also called Rigler sign

Classic radiologic sign of gallstone ileus: pneumobilia, intestinal obstruction and an ectopic gallstone

Which age group most commonly affected?

Most commonly seen in 6th to 7th decade of life

Females > Males

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