Presentation
The patient came to the emergency ward with diffuse abdominal pain, vomiting. At the outpatient clinic, an abdominal x-ray examination was performed, and small bowel ileus was confirmed. They directed the patient to the emergency ward. According to the first examination, he had diffuse pain, had no fever, and lacked intestinal sounds.
Patient Data
On the non-contrast phase study, the air in the central intrahepatic ducts is visible. There is a small amount of fluid around the gallbladder, and there is a small fistula between the gallbladder and the duodenum. The jejunum and ileum are distended, and we can see air-fluid levels in it. At the ileocecal valve is a part fat density, part calcified gallstone, which causes the obstruction. At the hepatic flexure, a small gallstone is also suspected. The mesenterium is edematous. A small amount of free fluid is also visible in the right lower quadrant. A simple cyst in the left kidney is also visible.
Case Discussion
The patient came to the emergency ward due to abdominal pain, vomiting, and an abdominal x-ray; a small bowel ileus was seen. We found the typical Rigler's triad (pneumobilia, small bowel obstruction, and gallstone outside the gallbladder). The patient went into surgery.