Gallstone ileus

Case contributed by Frank Gaillard
  • Note: This case has been tagged as "legacy" as it no longer meets image preparation and/or other case publication guidelines.



Erect and supine AXRs. Dilated small bowel loops with multiple air-fluid levels consistent with obstruction. A lamellated ovoid calcified density is projected over the lower abdomen in combination with branching air seen in the expected location of the biliary tree (pneumobilia). This combination of findings constitutes the Rigler triad of gallstone ileus. 

AXR from a few months earlier


In this AXR obtained months earlier, the gallstone can be seen in the RUQ. 

Annotated image

Rigler triad:

  1. pneumobilia
  2. small bowel obstruction
  3. gallstone obstructing distal small bowel

Case Discussion

Gallstone ileus with Rigler triad.

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