Imaging findings in patients with gallstone ileus:

  • an ectopic gallstone causing
  • partial or complete small bowel obstruction, and
  • pneumobilia and/or gallbladder lumen gas
Rigler triad gallstone ileus Radiopaedia 3

Rigler triad: 1. pneumobilia; 2. small bowel obstruction; 3. ectopic calcified gallstone
Case courtesy of Assoc Prof Frank Gaillard. Case rID: 6906

History of the Rigler triad

1941Leo George Rigler (1896-1979) described two cases, observed at autopsy, in which the manner of development of a choledochoduodenal and a cholecystoduodenal fistula could be demonstrated. 

The specific signs which permit a roentgenologic diagnosis of this condition are evidences of dynamic ileus, presence of gas or contrast medium in the biliary tract and direct or indirect visualization of the calculus

In 13 of 14 cases of gallstone obstruction in which roentgen examination was made, the exact diagnosis could have been made from the roentgenograms alone

Rigler, JAMA 1941
Rigler triad in gallstone ileus Leo Rigler 1941
Fig. 6 (case 2). Roentgenogram of abdomen in supine position, 1, dilated loops of intestine filled with gas; 2, gas in the stomach; 3, shadow of impacted stone with facet on upper surface; 4, faceted stone in gallbladder with gas above it, extending into biliary ducts. Presence of gas in the biliary tract, the remaining faceted stone in the gallbladder and evidences of intestinal obstruction permitted the exact diagnosis of gallstone obstruction. Rigler 1941

Associated Persons

Alternative names
  • Rigler’s triad


Historical references

Eponymous term review



the names behind the name

Third year M.D. student at the University of Notre Dame Fremantle. Passionate about emergency and retrieval medicine, rural practice and clinical research

BA MA (Oxon) MBChB (Edin) FACEM FFSEM. Emergency physician, Sir Charles Gairdner Hospital.  Passion for rugby; medical history; medical education; and asynchronous learning #FOAMed evangelist. Co-founder and CTO of Life in the Fast lane | Eponyms | Books | Twitter |

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