Rigler's triad in gallstone ileus: a rare form of bowel obstruction.

Gallstone ileus is a rare cause of bowel obstruction and abdominal x-ray can identify small bowel obstruction, pneumobilia, and ectopic gallstone (Rigler’s triad) in less than 30% of the patients. We present herein the case of an 80-year-old woman diagnosed 4 years prior with chronic calculous cholecystitis that was untreated. Physical examination and clinical anamnesis were consistent with bowel obstruction and the patient also presented with clinical and biochemical data of systemic inflammatory response syndrome (fever, tachycardia, and leukocytosis) and peritoneal irritation. Plain abdominal and chest x-rays were taken (figs. 1 and 2), identifying gastric distension and Rigler’s triad. An abdominal tomography scan corroborated the diagnosis of gallstone ileus (fig. 3). Laparotomy revealed a 5 x 4 x 4 cm gallstone located 1 m from the angle of Treitz, as well as segmental ischemia and necrotic patches in the mucosa of the small bowel (fig. 4). A 20-cm resection of the jejunum and a stapled side-to-side intestinal anastomosis were performed (fig. 5). The patient’s postoperative progression was satisfactory.