Rigler’s Triad
Rigler’s Triad Components
- Pneumobilia
- Air within the biliary tree due to a fistula between the gallbladder and gastrointestinal tract.
- Small Bowel Obstruction
- Mechanical obstruction caused by a gallstone that has entered the intestinal tract.
- Ectopic Gallstone
- A gallstone seen in an abnormal location, usually in the small bowel (often the terminal ileum).
⚡ Clinical Relevance:
Rigler’s triad is an important radiologic sign in Gallstone Ileus, typically seen on abdominal imaging (X-ray or CT).
Rigler’s Triad – 20 MCQs
1. Rigler’s Triad is most commonly associated with which condition?
Rigler’s Triad is a classic radiologic sign seen in gallstone ileus, caused by mechanical obstruction from a gallstone.
2. Which of the following is NOT a component of Rigler’s Triad?
Hepatomegaly is not part of Rigler’s Triad. The triad includes pneumobilia, small bowel obstruction, and ectopic gallstone.
3. Pneumobilia refers to:
Pneumobilia refers to the presence of air in the biliary system, often seen when a biliary-enteric fistula is present.
4. The most common site of obstruction in gallstone ileus is:
The terminal ileum is the narrowest part of the intestine, making it the most common site for gallstone impaction.
5. Which imaging modality is most sensitive for detecting Rigler’s Triad?
Abdominal CT scan is most sensitive and provides detailed visualization of the triad components in gallstone ileus.
6. An enterobiliary fistula in gallstone ileus most commonly connects:
The most common enterobiliary fistula in gallstone ileus is between the gallbladder and the duodenum.
7. The typical clinical presentation of gallstone ileus includes:
Gallstone ileus typically presents with intermittent symptoms of small bowel obstruction, such as abdominal pain and vomiting.
8. Rigler’s Triad is best visualized on which phase of CT imaging?
Contrast-enhanced CT provides better differentiation of soft tissues, stones, and bowel structures, making Rigler’s Triad easier to identify.
9. Which population is most commonly affected by gallstone ileus?
Gallstone ileus is most commonly seen in elderly women due to a higher prevalence of gallstones in this group.
10. Pneumobilia is best detected on:
CT scan is highly sensitive for detecting pneumobilia due to its ability to clearly display air in the biliary tree.
11. Gallstone ileus represents what percentage of mechanical small bowel obstruction cases?
Gallstone ileus accounts for 1–4% of all mechanical small bowel obstructions.
12. Which of the following is the least common location for ectopic gallstone lodging?
The rectum is an extremely rare site for gallstone impaction compared to the terminal ileum, jejunum, and duodenum.
13. Treatment of gallstone ileus generally involves:
Surgery is the definitive treatment to remove the obstructing gallstone and relieve small bowel obstruction.
14. Gallstone ileus is more common in which sex?
Due to the higher prevalence of gallstones in females, gallstone ileus occurs more commonly in elderly women.
15. The “Rigler’s sign” refers to the presence of:
Rigler’s sign refers specifically to pneumobilia, one of the key components of Rigler’s Triad.
16. Which factor increases the risk of gallstone ileus?
Chronic cholecystitis predisposes to fistula formation, facilitating gallstone passage into the bowel.
17. What is the classic patient demographic for gallstone ileus?
The classic patient is an elderly woman due to high gallstone prevalence and anatomical changes with age.
18. Which is a potential complication if gallstone ileus is left untreated?
Untreated gallstone ileus may lead to bowel perforation and peritonitis.
19. Gallstone ileus requires which of the following for definitive diagnosis?
CT imaging provides definitive diagnosis by clearly showing all three components of Rigler’s Triad.
20. In the management of gallstone ileus, when is fistula repair typically performed?
Fistula repair may be performed during the initial surgery if the patient is stable and surgical risk is acceptable.
