A 70-year-old woman presents with 2 days of colicky abdominal pain, distension, and vomiting. She has had intermittent episodes over the past month. Abdominal radiograph shows dilated small bowel loops, gas in the biliary tree, and a radio-opaque shadow in the right iliac fossa. What is the most likely diagnosis?
- A Emphysematous cholecystitis with ileus
- B Gallstone ileus ✓
- C Cholangiocarcinoma with small bowel metastasis
- D Chronic pancreatitis with duodenal obstruction
Correct answer: B. Gallstone ileus
Explanation
The combination of pneumobilia, small bowel obstruction, and an ectopic calcified stone is Rigler's triad, pathognomonic for gallstone ileus. It results from a large gallstone eroding through a chronically inflamed gallbladder wall into the adjacent duodenum (cholecystoduodenal fistula) and impacting usually at the narrow terminal ileum. Emphysematous cholecystitis causes gas in the gallbladder wall rather than pneumobilia with mechanical obstruction.
Reference: Bailey and Love's Short Practice of Surgery, 27th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.