Rigler Triad in Gallstone Ileus: Case Report and Literature Review

Abstract

Gallstone ileus is an uncommon complication of calculous cholecystitis, which can lead to a gastro-intestinal obstruction. A non-specific clinical presentation is frequent. Imaging studies can present characteristic radiological signs. We present a 56-year-old female patient with constipation for the past 72 hours, colicky intermittent abdominal pain and vomiting. Plain CT-scan showed Rigler’s triad. Gallstone ileus was diagnosed and laparotomy was performed with stone extraction by enterolitotomy. Significant morbimortality is associated to a delayed diagnosis more often in the context of elderly patients. Complementary imaging studies are needed for conclusive diagnosis, Rigler’s triad, Petren and Forchet sign are pathognomonic for gallstone ileus. Surgical approach is essential in the resolution of this entity.