A 70-year-old woman presents with abdominal distension and bilious vomiting. Plain abdominal radiograph shows dilated jejunal loops, branching radiolucent gas shadows projected over the liver, and a 2 cm rounded calcified density in the right lower quadrant. What is this classic radiographic triad called?

• A Quincke's triad
• B Rigler's triad ✓
• C Whipple's triad
• D Carney's triad

Explanation

The findings are pneumobilia, small bowel obstruction and an ectopic radio-opaque gallstone, which together form Rigler's triad of gallstone ileus. It results from a cholecystoenteric fistula allowing a large stone to impact, classically at the terminal ileum. Quincke's triad refers to intermittent jaundice, pain and fever in choledocholithiasis, and Whipple's triad describes hypoglycaemia features in insulinoma, so both are anatomically and clinically unrelated here.

Reference: Grainger and Allison's Diagnostic Radiology, 7th ed.

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