Rigler triad in gallstone ileus

Roothans, Dessie; Anguille, Sébastien

doi:10.1503/cmaj.121432

Cited by 14 publications

(21 citation statements)

References 3 publications

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“…The most commonly obstructed part is the terminal ileum, which leads to the gallstone ileus [2,4,10]. Classic abdominal radiographic signs of pneumobilia, mechanical bowel obstruction, and ectopic gallstone were first described by Rigler, but in around one half of the patients there are usually two out of three signs [1,3,11]. It rarely happens that patients vomit gallstones passed through fistula to the stomach.…”

Section: Discussionmentioning

confidence: 99%

“…Душан Шапоњски 1 , Александра Ђурић-Стефановић 1,2 , Александра Јанковић 1 , Милица Митровић-Јовановић 1 , Стефан Кмезић 3 , Слађана Михајловић 2,4 , Иван Поповић 5 , Ђорђије Шарановић 6,7 1 Клинички центар Србије, Прва хируршка клиника, Центар за радиологију и магнетну резонанцу, Одељење дигестивне радиологије, Београд, Србија; 2 Универзитет у Београду, Медицински факултет, Београд, Србија; 3 Клинички центар Србије, Прва хируршка клиника, Београд, Србија; 4 Клиничко-болнички центар "Др Драгиша Мишовић -Дедиње", Београд, Србија; 5 Општа болница "Стефан Високи", Смедеревска Паланка, Србија; 6 Општа болница "Медигруп", Београд, Србија; 7 Универзитет у Бањој Луци, Медицински факултет, Бања Лука, Република Српска, Босна и Херцеговина…”

Section: сажетакunclassified

“…This entity is more common in the elderly and is manifested with a number of nonspecific signs and symptoms. The pathognomonic triad (Rigler triad) of pneumobilia, small-bowel distention, and ectopic gallstones on conventional abdominal radiographs is seen in 30-35% of all cases with gallstone ileus [1][2][3][4][5]. Duodenal obstruction caused by an ectopic gallstone happens in only 1-3% of the patients and is known as the Bouveret syndrome [1,6,7].The rarest complication is a floating non-obstructing gallstone trapped in the stomach, which can also lead to gastric outlet, persistent emesis, and esophageal rupture (Boerhaave syndrome), as reported in the study by Modi et al [8].…”

Section: Introductionmentioning

confidence: 99%

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Spontaneous cholecystoduodenal fistula - spectrum of complications

et al. 2019

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Introduction Spontaneous cholecystoduodenal fistula is a rare complication of the gallbladder calculosis. Bowel obstruction is the complication in less than 1% of these patients. The pathognomonic triad (Rigler triad) of pneumobilia, small-bowel distention, and ectopic gallstones is typical for gallstone ileus. In only 1-3% of the patients with bowel obstruction by ectopic gallstone the localization of obstruction is in the duodenum, and it is called Bouveret syndrome. The rarest complication is a floating non-obstructing gallstone trapped in the stomach. Outline of cases We present three elderly female patients with persistent abdominal pain and known gallbladder calculosis in the patients' histories. Plain radiography of the thorax and abdomen and ultrasound were performed as the first choice and contrast-enhanced computer tomography (CT) was done subsequently. In the first patient, CT and magnetic resonance imaging (MRI) showed signs of pneumobilia, cholecystoduodenal fistula, and the presence of the gallstone in the stomach. The iodine contrast X-ray swallow test revealed a cholecysto-duodenal bulb fistula and floating calculus in the stomach, confirmed by endoscopy. In the second patient with persistent abdominal pain, CT and barium swallow test showed signs of pneumobilia, cholecystoduodenal fistula, and two ectopic gallstones obstructing duodenum-Bouveret syndrome. The third case showed signs of the Rigler triad-typical signs of gallstone ileus. Conclusion Spontaneous cholecystoduodenal fistula is a rare condition with possible complications such as Bouveret syndrome, gallstone ileus and floating, non-obstructive gallstones in the stomach, as the rarest possible complication. CT, MRI with magnetic resonance cholangiopancreatography, as well as the contrast X-ray swallow test can be very helpful in the detection of the bilio-enteric fistula and ectopic gallstones.

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Section: Discussionmentioning

confidence: 99%

Section: сажетакunclassified

Section: Introductionmentioning

confidence: 99%

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Spontaneous cholecystoduodenal fistula - spectrum of complications

et al. 2019

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“…According to Rigler, gallstone ileus is simply diagnosed based on plain abdominal finding showing air in the biliary tract (pneumobilia) and radiopaque stones projection in the dilated small intestine. 13,14 Abdominal ultrasound examinations and abdominal CT scans were not performed on the first case since the plain abdominal x-ray had provide the information for a gallstone ileus. ERCP in the second case carried out in another hospital indicated by the presence of jaundice.…”

Section: Discussionmentioning

confidence: 99%

Gallstone Ileus in Cipto Mangunkusumo General Hospital, Jakarta: A Case Series

Lalisang

Hehuwat

Lalisang

et al. 2019

NRJS

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Introduction. Gallstone ileus is an uncommon mechanical bowel obstruction caused by a gallstone in the gastrointestinal tract which enters due to bile-enteric fistulae. This study aims to describe gallstone ileus and its management. Method. Data were retrospectively collected from medical records. Clinical manifestations, laboratory data, supporting radiographic examinations, treatment, postoperative care, and outcomes were collected. Results. We report two gallstone ileus cases at Cipto Mangunkusumo General Hospital, Jakarta which admitted in the last 20 years. The first case was a woman 33 years in 2002 and the second was man 45 years in 2017. Ileus was the main clinical symptoms. Gallstone ileus was diagnosed with preoperatively based on clinical and radiology findings. Laparotomy was performed and ileostomy for stones evacuation and cholecystectomy were performed without bile-enteric fistula repair. Large black stones were found at terminal ileum which made the obstruction. Conclusion. Gallstone ileus was an uncommon disease which can be treated and has a good prognosis. Plain abdominal x-ray has an important role in diagnosis and treatment approach.

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“…Although some medical centers make right diagnosis using advanced imaging (CT allows direct visualization of cholecystoenteric fistula) 6 , in centers without this technology, the diagnosis is based on clinical suspicious (Rigler triad: airfluid levels, aerobilia and radiopaque gallstone in atypical position) 7 . Little more aggressive than laparoscopy and less invasive than traditional laparotomy, minilaparotomy is a valid therapeutic approach and is recommended when diagnosis of biliary ileus is high suspected.…”

Section: Discussionmentioning

confidence: 99%

Minilaparotomy for biliary ileus: A different approach

Díaz-Rosales

2015

archmed

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Introduction: Biliary ileus is a rare cause of mechanical bowel obstruction and results from the passage of gallstones into the small bowel. Case presentation: 62-year old woman with episode of biliary ileus was underwent to minilaparotomy (5 cm) to extract gallstone from small bowel. In this particularly patient we used this approach, because we had highly suspicious diagnostic. The patient was discharged on postoperative day 5 without any complication. Conclusion: Minilaparotomy approach is a feasible option in centers without laparoscopy surgery, with excellent results when one-stage procedure is not considered.

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Rigler triad in gallstone ileus

Cited by 14 publications

References 3 publications

Spontaneous cholecystoduodenal fistula - spectrum of complications

Spontaneous cholecystoduodenal fistula - spectrum of complications

Gallstone Ileus in Cipto Mangunkusumo General Hospital, Jakarta: A Case Series

Minilaparotomy for biliary ileus: A different approach

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