Gallstone Ileus in CTand Rigler’s Triad

A 65-year-old female presents with mild abdominal distention, nausea, and vomiting. A KUB indicates pneumobilia and paucity of air in the colon. What is the most likely diagnosis ?

Gallstone Ileus is Impaction of gallstone in ileum after passing through a biliary-enteric fistula,It is Unusual complication of chronic cholecystitis

· 60% are cholecystoduodenal fistulae; others are cholecystocolonic and cholecystogastric fistulae

· Average age of patient is 70 years old

· Delay in diagnosis-------- Mortality of 15-20%

** Rigler’s Triad

• Pneumobilia
• SBO (Small-Bowel Obstruction)
• Impacted gallstone-usually in the terminal ileum at ileocecal valve

Two axial images from a contrast-enhanced CT of the abdomen show air in the gall bladder (red arrow) and air in the common bile duct (blue arrow) representing pneumobilia, the gallstone in the small bowel lumen (yellow arrow) and dilated and fluid-filled loops of small bowel from small bowel obstruction (green arrow)