Rigler triad of small bowel (SB) obstruction, gas in biliary tree, and ectopic gallstone
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Location: Points of luminal narrowing of bowel; duodenum, ligament of Treitz, ileocecal valve, sigmoid colon
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CT findings
Gallstone surrounded by gas in bowel loop
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Cholesterol stones near-water density, often with calcified rim
Collapsed gallbladder, pneumobilia (gas within GB ± bile duct lumen)
Dilated bowel with transition to collapsed bowel at impacted gallstone
TOP DIFFERENTIAL DIAGNOSES
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Dropped gallstone (intraperitoneal, not intraluminal)
PATHOLOGY
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Occurs with chronic cholecystitis
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Delayed (up to 2 months) complication of ERCP
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Diagnosis frequently delayed or missed
CLINICAL ISSUES
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Most common signs/symptoms: Intermittent acute colicky abdominal pain (20-30%), nausea, vomiting, fever, distension, obstipation
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Gallstone erodes inflamed GB wall, passes into GI tract (usually duodenum) → bowel obstruction
DIAGNOSTIC CHECKLIST
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Consider in elderly woman with recurrent RUQ pain, recently more severe and prolonged vomiting
Related
Diagnostic Imaging_ Gastrointes - Michael P Federle
