Which combination correctly describes Rigler's triad on plain abdominal radiography?

• A Coffee bean sign, pneumobilia, and free fluid
• B Pneumoperitoneum, pneumobilia, and an ectopic calcified gallstone
• C Pneumatosis intestinalis, portal venous gas, and dilated small bowel loops
• D Pneumobilia, dilated small bowel loops, and an ectopic calcified gallstone ✓

Explanation

Gallstone ileus follows a cholecystoduodenal fistula through which a large stone impacts, usually at the terminal ileum. The triad is aerobilia (pneumobilia), small bowel dilation, and a radio-opaque ectopic gallstone, though all three are seen together in only a minority of films. Free intraperitoneal air indicates perforation and is not part of the triad.

Reference: Bailey and Love's Short Practice of Surgery, 27th ed.

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