Rolling in the Deep: Imaging Findings and Diagnostic Pearls in Gallstone Ileus

Figure 3

Upright abdominal radiograph shows the incomplete manifestation of the classical Rigler’s triad in a patient with gallstone ileus. Note the paucity of intestinal gas, with dilated small bowel loops in the left upper abdomen and air-fluid levels. A stone with a thin peripheral calcified rim is visible (arrowheads), but pneumobilia is not detectable. Note curvilinear areas of increased opacity in the right upper quadrant, projecting into the gallbladder fossa (arrow).