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

摘要

Gallstone ileus is a rare cause of bowel obstruction andabdominal x-ray can identify small bowel obstruction, pneumobilia, and ectopic gallstone (Rigler’s triad) in less than30% of the patients. We present herein the case of an80-year-old woman diagnosed 4 years prior with chroniccalculous cholecystitis that was untreated. Physical examination and clinical anamnesis were consistent with bowelobstruction and the patient also presented with clinical andbiochemical data of systemic inflammatory response syndrome (fever, tachycardia, and leukocytosis) and peritonealirritation. Plain abdominal and chest x-rays were taken(figs. 1 and 2), identifying gastric distension and Rigler’striad. An abdominal tomography scan corroborated the diagnosis of gallstone ileus (fig. 3). Laparotomy revealed a 5 x4 x 4 cm gallstone located 1 m from the angle of Treitz,as well as segmental ischemia and necrotic patches in themucosa of the small bowel (fig. 4). A 20-cm resection ofthe jejunum and a stapled side-to-side intestinal anastomosis were performed (fig. 5). The patient’s postoperativeprogression was satisfactory.