Gallstone ileus with multiple stones: Where Rigler triad meets Bouveret’s syndrome

Abstract

A 53-year-old man with multiple medical conditions presented to the emergency department with complaints of vomiting, anorexia and diffuse colicky abdominal pain for 3 d. A computed tomography scan of the abdomen and pelvis showed radiographic findings consistent with Rigler triad seen in small proportion of patients with small bowel obstruction secondary to gallstone impaction. In addition there was a gastric outlet obstruction, consistent with Bouveret’s syndrome. The patient underwent an exploratory laparotomy and enterotomy with multiple stones extracted. The patient had an uneventful post-surgical clinical course and was discharged home.

Keywords: Rigler triad; Gallstone ileus; Bouveret’s syndrome; Small bowel obstruction

Core tip: Gallstone ileus is an uncommon cause of small bowel obstruction. The classic finding of Rigler triad is often seen. Bouveret’s syndrome is a subset of gallstone ileus, and usually presents with gastric outlet obstruction as opposed to small bowel obstruction. We present a case where there were multiple stones, each causing obstruction in different locations. Clinicians need to be aware of the possibility of multiple stones when deciding treatment options.