https://doi.org/10.4081/crest.2023.12

The Rigler’s triad: a case of gallstone ileus

Vol. 1 No. 1 (2023)
Submitted: May 12, 2023
Accepted: July 2, 2023
Published: July 10, 2023
Rigler’s triad, gallstone ileus, bowel obstruction, cholecystoduodenal fistula
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Authors

  • Giulia Montori • giulia.montori@gmail.com General Surgery Department, ULSS 2 Marca Trevigiana, Vittorio Veneto Hospital, Vittorio Veneto (TV), Italy.
  • Giuseppa Procida General Surgery Department, ULSS 2 Marca Trevigiana, Vittorio Veneto Hospital, Vittorio Veneto (TV), Italy.
  • Andrea Dal Borgo General Surgery Department, ULSS 2 Marca Trevigiana, Vittorio Veneto Hospital, Vittorio Veneto (TV), Italy.
  • Edelweiss Licitra General Surgery Department, ULSS 2 Marca Trevigiana, Vittorio Veneto Hospital, Vittorio Veneto (TV), Italy.
  • Tobia Gobbi General Surgery Department, ULSS 2 Marca Trevigiana, Vittorio Veneto Hospital, Vittorio Veneto (TV), Italy.
  • Francesca Fappiano General Surgery Department, ULSS 2 Marca Trevigiana, Vittorio Veneto Hospital, Vittorio Veneto (TV), Italy.
  • Federica Salemi General Surgery Department, ULSS 2 Marca Trevigiana, Vittorio Veneto Hospital, Vittorio Veneto (TV), Italy.
  • Ferdinando Agresta General Surgery Department, ULSS 2 Marca Trevigiana, Vittorio Veneto Hospital, Vittorio Veneto (TV), Italy.

Rigler’s triad is an extremely rare syndrome that accounts for 4% of all cases of small intestinal obstruction (SBO). This illness is distinguished by three clinical and radiological features: pneumobilia, a severe intestinal blockage, and an abnormally placed gallstone in the gallbladder. An 84-year-old woman arrives at the Emergency Department with symptoms of SBO. The CT scan is essential for detecting the trio. An emergency laparoscopy with an enterotomy and gallstone extraction was conducted successfully. The Rigler’s triad should be suspected in elderly individuals with a history of gallstones in the gallbladder, especially in the emergency scenario. Large and solitary gallstones in the gallbladder that are asymptomatic should be candidates for cholecystectomy. In conclusion, this case is a very didactic instance, particularly because of the crisp CT images that can assist surgeons in identifying gallstone ileus and the mini-invasive method that can also benefit in an emergency context.

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Citations

Crossref
Scopus
Google Scholar
Europe PMC
Ploneda-Valencia CF, Gallo-Morales M, Rinchon C, et al. Gallstone ileus: An overview of the literature. Rev Gastroenterol Mex 2017;82:248-54. DOI: https://doi.org/10.1016/j.rgmxen.2017.05.001
Nun ̃o-Guzmán CM, Arróniz-Jáuregui J, Moreno-Pérez PA, et al. Gallstone ileus: One-stage surgery in a patient with intermittent obstruction. World J Gastrointest Surg 2010;2:172-6. DOI: https://doi.org/10.4240/wjgs.v2.i5.172
Beuran M, Ivanov I, Venter MD. Gallstone ileus-clinical and therapeutic aspects. J Med Life 2010;3:365-71.
Agresta F, Bedin N. Gallstone ileus as a complication of acute cholecystitis. Laparoscopic diagnosis and treatment. Surg Endosc 2002;16:1637. DOI: https://doi.org/10.1007/s00464-002-4215-4
Agresta F, Ansaloni L, Baiocchi GL, et al. Laparoscopic approach to acute abdomen from the Consensus Development Conference of the Società Italiana di Chirurgia Endoscopica e nuove tecnologie (SICE), Associazione Chirurghi Ospedalieri Italiani (ACOI), Società Italiana di Chirurgia (SIC), Società Italiana di Chirurgia d'Urgenza e del Trauma (SICUT), Società Italiana di Chirurgia nell'Ospedalità Privata (SICOP), and the European Association for Endoscopic Surgery (EAES). Urg Endosc 2012;26:2134-64. DOI: https://doi.org/10.1007/s00464-012-2331-3
Williams NE, Gundara JS, Roser S, et al. Disease spectrum and use of cholecystolithotomy in gallstone ileus. Hepato- biliary Pancreat Dis Int 2012;11:553-7. DOI: https://doi.org/10.1016/S1499-3872(12)60224-0
Lamberts MP. Indications of cholecystectomy in gallstone disease. Curr Opin Gastroenterol 2018;34:97-102. DOI: https://doi.org/10.1097/MOG.0000000000000419
Beuran M, Venter MD, Ivanov I, et al. Iftimie-Nastase I and Venter DP. Gallstone ileus - Still a problem with heart. Ann Acad Rom Sci Ser Med Sci 2012;3:5-28.
Freeman MH, Mullen MG, Friel CM. The Progression of Cholelithiasis to Gallstone Ileus: Do Large Gallstones Warrant Surgery? J Gastrointest Surg 2016;20:1278-80. DOI: https://doi.org/10.1007/s11605-016-3096-0
Sauerland S, Agresta F, Bergamaschi R, et al. Laparoscopy for abdominal emergencies: evidence-based guidelines of the European Association for Endoscopic Surgery. Surg Endosc 2006;20:14-29. DOI: https://doi.org/10.1007/s00464-005-0564-0
American Cancer Society. Gallbladder Cancer Causes, Risk Factors, and Prevention. Accessed: June 9, 2020. Available from: https://www.cancer.org/content/dam/CRC/PDF/Public/8630.00.pdf
Nordenstedt H, Mattsson F, El-Serag H, et al. Gallstones and cholecystectomy in relation to risk of intra- and extrahepatic cholangiocarcinoma. Br J Cancer 2012;10:1011-5. DOI: https://doi.org/10.1038/bjc.2011.607

How to Cite

Montori, G., Procida, G., Dal Borgo, A., Licitra, E., Gobbi, T., Fappiano, F., Salemi, F., & Agresta, F. (2023). The Rigler’s triad: a case of gallstone ileus. Case Reports in Emergency Surgery and Trauma, 1(1). https://doi.org/10.4081/crest.2023.12
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