Skip to main content

Main menu

  • Home
  • COVID-19
    • Articles & podcasts
    • Blog posts
    • Collection
    • News
  • Content
    • Current issue
    • Past issues
    • Early releases
    • Collections
    • Sections
    • Blog
    • Infographics & illustrations
    • Podcasts
    • Classified ads
  • Authors
    • Overview for authors
    • Submission guidelines
    • Submit a manuscript
    • Forms
    • Editorial process
    • Editorial policies
    • Peer review process
    • Publication fees
    • Reprint requests
  • CMA Members
    • Overview for members
    • Earn CPD Credits
    • Print copies of CMAJ
    • Career Ad Discount
  • Subscribers
    • General information
    • View prices
  • Alerts
    • Email alerts
    • RSS
  • JAMC
    • À propos
    • Numéro en cours
    • Archives
    • Sections
    • Abonnement
    • Alertes
  • CMAJ JOURNALS
    • CMAJ Open
    • CJS
    • JAMC
    • JPN

User menu

Search

  • Advanced search
CMAJ
  • CMAJ JOURNALS
    • CMAJ Open
    • CJS
    • JAMC
    • JPN
CMAJ

Advanced Search

  • Home
  • COVID-19
    • Articles & podcasts
    • Blog posts
    • Collection
    • News
  • Content
    • Current issue
    • Past issues
    • Early releases
    • Collections
    • Sections
    • Blog
    • Infographics & illustrations
    • Podcasts
    • Classified ads
  • Authors
    • Overview for authors
    • Submission guidelines
    • Submit a manuscript
    • Forms
    • Editorial process
    • Editorial policies
    • Peer review process
    • Publication fees
    • Reprint requests
  • CMA Members
    • Overview for members
    • Earn CPD Credits
    • Print copies of CMAJ
    • Career Ad Discount
  • Subscribers
    • General information
    • View prices
  • Alerts
    • Email alerts
    • RSS
  • JAMC
    • À propos
    • Numéro en cours
    • Archives
    • Sections
    • Abonnement
    • Alertes
  • Visit CMAJ on Facebook
  • Follow CMAJ on Twitter
  • Follow CMAJ on Pinterest
  • Follow CMAJ on Youtube
  • Follow CMAJ on Instagram
Practice

Rigler triad in gallstone ileus

Dessie Roothans and Sébastien Anguille
CMAJ October 01, 2013 185 (14) E690; DOI: https://doi.org/10.1503/cmaj.121432
Dessie Roothans
Department of Internal Medicine (Roothans, Anguille), Antwerp University Hospital, Antwerp, Belgium
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Sébastien Anguille
Department of Internal Medicine (Roothans, Anguille), Antwerp University Hospital, Antwerp, Belgium
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • For correspondence: sebastien.anguille@uza.be
  • Article
  • Figures & Tables
  • Responses
  • Metrics
  • PDF
Loading

A 90-year-old man was admitted with acute-onset, pressing retrosternal pain and diffuse abdominal discomfort. Electrocardiography and cardiac troponin levels ruled out an acute coronary syndrome. Plain radiography of the abdomen (Figure 1A) showed multiple air–fluid levels and air in the biliary tree (pneumobilia). Computed tomography (CT) scanning showed an impacted ectopic gallstone, consistent with a diagnosis of gallstone ileus (Figure 1B). We removed a 4-cm gallstone from the jejunal lumen during explorative laparotomy; because of the patient’s age, we chose not to repair his cholecystoduodenal fistula. After an initially uncomplicated postoperative course, he died of cardiac arrest 1 week after surgery.

Figure 1:
  • Download figure
  • Open in new tab
  • Download powerpoint
Figure 1:

(A) Plain abdominal radiograph of a 90-year-old man with acute retrosternal pain showing air–fluid levels, predominantly in the small bowel, and pneumobilia (arrowhead). (B) Computed tomography scan showing an ectopic gallstone impacted in the lumen of the small bowel (arrow).

Gallstone ileus, a rare complication of chole-lithiasis, is caused by intestinal impaction of a gallstone that has migrated through a cholecystoenteric fistula. Mortality is high, up to 22.7%,1 largely because most patients are elderly with associated comorbidities. The nonspecific clinical presentation tends to delay diagnosis and treatment.1 The classic radiologic sign of gallstone ileus is the Rigler triad (also called Rigler sign): pneumobilia, intestinal obstruction and an ectopic gallstone.2,3 Plain abdominal radiography can be valuable in the initial workup of a suspected small-bowel obstruction. However, gallstone ileus is easily missed on plain radiographs, because most gallstones are radiolucent and all 3 elements of the Rigler triad show up in only 15% of cases.2 Although formal guidelines are lacking, expert opinion supports the early use of abdominal CT scanning when gallstone ileus is suspected, with the Rigler triad seen in up to 80% of cases when CT is used.2,3 The decision to intervene surgically depends on the patient’s clinical condition. Enterolithotomy alone (without cholecystectomy and fistula repair) is the preferred option in frail, older patients.1

Footnotes

  • Competing interests: None declared.

  • This article has been peer reviewed.

References

  1. ↵
    1. Ayantunde AA,
    2. Agrawal A
    . Gallstone ileus: diagnosis and management. World J Surg 2007;31:1292–7.
    OpenUrlPubMed
  2. ↵
    1. Lassandro F,
    2. Gagliardi N,
    3. Scuderi M,
    4. et al
    . Gallstone ileus analysis of radiological findings in 27 patients. Eur J Radiol 2004;50:23–9.
    OpenUrlCrossRefPubMed
  3. ↵
    1. Lassandro F,
    2. Romano S,
    3. Ragozzino A,
    4. et al
    . Role of helical CT in diagnosis of gallstone ileus and related conditions. AJR Am J Roentgenol 2005;185:1159–65.
    OpenUrlCrossRefPubMed
PreviousNext
Back to top

In this issue

Canadian Medical Association Journal: 185 (14)
CMAJ
Vol. 185, Issue 14
1 Oct 2013
  • Table of Contents
  • Index by author

Article tools

Respond to this article
Print
Download PDF
Article Alerts
To sign up for email alerts or to access your current email alerts, enter your email address below:
Email Article

Thank you for your interest in spreading the word on CMAJ.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
Rigler triad in gallstone ileus
(Your Name) has sent you a message from CMAJ
(Your Name) thought you would like to see the CMAJ web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Citation Tools
Rigler triad in gallstone ileus
Dessie Roothans, Sébastien Anguille
CMAJ Oct 2013, 185 (14) E690; DOI: 10.1503/cmaj.121432

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
‍ Request Permissions
Share
Rigler triad in gallstone ileus
Dessie Roothans, Sébastien Anguille
CMAJ Oct 2013, 185 (14) E690; DOI: 10.1503/cmaj.121432
Digg logo Reddit logo Twitter logo Facebook logo Google logo Mendeley logo
  • Tweet Widget
  • Facebook Like
  • Google Plus One

Jump to section

  • Article
    • Footnotes
    • References
  • Figures & Tables
  • Responses
  • Metrics
  • PDF

Related Articles

  • No related articles found.
  • PubMed
  • Google Scholar

Cited By...

  • No citing articles found.
  • Google Scholar

More in this TOC Section

  • “Superscan” in diffusion-weighted imaging with background body suppression magnetic resonance imaging
  • Using intranasal corticosteroids
  • Langerhans cell histiocytosis in a 5-month-old baby
Show more Practice

Similar Articles

Collections

  • Sections
    • Clinical Images
  • Topics
    • Gastroenterology

Content

  • Current issue
  • Past issues
  • Collections
  • Sections
  • Blog
  • Podcasts
  • Alerts
  • RSS
  • Early releases

Information for

  • Advertisers
  • Authors
  • Reviewers
  • CMA Members
  • Media
  • Reprint requests
  • Subscribers

About

  • General Information
  • Journal staff
  • Editorial Board
  • Governance Council
  • Journal Oversight
  • Careers
  • Contact
  • Copyright and Permissions

Copyright 2021, Joule Inc. or its licensors. All rights reserved. ISSN 1488-2329 (e) 0820-3946 (p)

All editorial matter in CMAJ represents the opinions of the authors and not necessarily those of the Canadian Medical Association or its subsidiaries.

Powered by HighWire