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

Figure 9

Contrast-enhanced computed tomography in the same patient than Figure 2, after nasogastric tube positioning (tip with black arrowhead in (a) demonstrates the CT counterpart of classical Rigler’s triad: pneumobilia (white arrowheads in (a) and (b)), a peripherally calcified stone (black arrow in (c)) impacted in the proximal ileum lumen, and concomitant signs of mechanical intestinal obstruction, including dilated and partially fluid-filled small bowel loops proximal to the site of obstruction and decompressed distal bowel; air-fluid levels and “string of beads” sign (white arrow in (b)) are visible as well. An additional smaller calculus, not visible at abdominal radiography, is seen in (a) (white arrow).

(a)

(b)

(c)