Year 2024 / Volume 116 / Number 5
Letter
Upper gastrointestinal bleeding and Rigler triad

286-287

DOI: 10.17235/reed.2023.9731/2023

Margarita Fernández-de la Varga, Isabel Pérez Valle, Carlos Ordieres Díaz, Álvaro Gejo Benéitez, Pedro Amor Martín, Marta Álvarez Posadilla, Fernando Fernández Cadenas, Adrián Huergo Fernández,

Abstract
Gallstone ileus is a rare complication of cholelithiasis, characterized by mechanical bowel obstruction due to a biliary calculus originating from a bilioenteric fistula. The Rigler triad, consisting of aerobilia, ectopic gallstone, and intestinal obstruction, is rarely observed in its complete form. We present the case of a 92-year-old male with a history of acute lithiasic cholecystitis who presented to the Emergency department with acute epigastric pain. Initial evaluation revealed gallbladder dilatation, gallstones, and gallbladder wall thickening suggestive of acute cholecystitis. During hospitalization, the patient experienced an episode of hematemesis, leading to the diagnosis of a cholecystoduodenal fistula and a large blood clot in the duodenal bulb. Further imaging showed an ectopic gallstone causing small bowel obstruction. The patient underwent urgent surgery for stone extraction, followed by endoscopic intervention for the bleeding vessel identified at a subsequent gastroscopy. Unfortunately, the patient had a poor postoperative course and passed away seven days later. This case report highlights the exceptional occurrence of both the Rigler triad and upper gastrointestinal bleeding in a patient with gallstone ileus. Surgical intervention is crucial for the initial resolution of intestinal obstruction, followed by cholecystectomy and repair of the bilioenteric fistula. Awareness of these rare presentations is important for timely diagnosis and appropriate management of this uncommon complication of cholelithiasis.
Share Button
New comment
Comments
No comments for this article
References
1. Halabi WJ, Kang CY, Ketana N, Lafaro KJ, Nguyen VQ, Stamos MJ, et al. Surgery for gallstone ileus: A nationwide comparison of trends and outcomes. Ann Surg. 2014;259(2):329–35.
2. Kumar N, Anjum R, Mani R, Karki B. Neglected Gallstone Disease Presented As Gallstone Ileus: A Rare Cause of Intestinal Obstruction. Cureus. 2021;13(9).
3. Rigler L, Borman C, Noble J. Gallstone obstruction: pathogenesis and Roentgen manifestations. J Am Med Assoc. 1941;117(21):1753–9.
4. Goyes D, Trivedi HD. Upper Gastrointestinal Bleeding: A Potential Precursor to Bouveret’s Syndrome. Cureus. 2021;13(4).
5. Moberg AC, Montgomery A. Laparoscopically assisted or open enterolithotomy for gallstone ileus. Br J Surg. 2007;94(1):53–7.
Related articles

Letter

A full hemostatic repertoire in a complex cirrhotic patient

DOI: 10.17235/reed.2022.9039/2022

Digestive Diseases Image

Bezoar: an uncommon cause of upper gastrointestinal bleeding

DOI: 10.17235/reed.2021.8311/2021

Letter

COVID-19 and aorto-enteric fistula

DOI: 10.17235/reed.2021.8272/2021

Letter to the Editor

Gangliocytic paraganglioma: an unusual cause of upper gastrointestinal bleeding

DOI: 10.17235/reed.2017.4808/2016

Digestive Diseases Image

Rigler triad in gallstone ileus

Case Report

Downhill varices: an uncommon cause of upper gastrointestinal bleeding

DOI: 10.17235/reed.2015.3697/2015

Citation tools
Fernández-de la Varga M, Pérez Valle I, Ordieres Díaz C, Gejo Benéitez Á, Amor Martín P, Álvarez Posadilla M, et all. Upper gastrointestinal bleeding and Rigler triad. 9731/2023


Download to a citation manager

Download the citation for this article by clicking on one of the following citation managers:

Metrics
This article has received 150 visits.
This article has been downloaded 19 times.

Statistics from Dimensions


Statistics from Plum Analytics

Publication history

Received: 17/05/2023

Accepted: 23/05/2023

Online First: 14/06/2023

Published: 09/05/2024

Article Online First time: 28 days

Article editing time: 358 days


Share
This article hasn't been rated yet.
Reader rating:
Valora este artículo:




Asociación Española de Ecografía Digestiva Sociedad Española de Endoscopia Digestiva Sociedad Española de Patología Digestiva
The Spanish Journal of Gastroenterology is the official organ of the Sociedad Española de Patología Digestiva, the Sociedad Española de Endoscopia Digestiva and the Asociación Española de Ecografía Digestiva
Cookie policy Privacy Policy Legal Notice © Copyright 2023 y Creative Commons. The Spanish Journal of Gastroenterology