Gallstone ileus

Case contributed by Assoc Prof Frank Gaillard


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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Case information

rID: 6906
Published: 26th Aug 2009
Last edited: 7th Apr 2020
Inclusion in quiz mode: Included

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