A 65-year-old male presents with abdominal pain, vomiting, and a history of multiple episodes of cholecystitis. X ray image is given below.What is the most likely diagnosis?
A. Acute cholecystitis B. Gallstone ileus C. Small bowel volvulus D. Duodenal perforation
Answer:B. Gallstone ileus
Explanation: Rigler's Triad consists of pneumobilia, small bowel obstruction, and an ectopic gallstone, which is diagnostic of gallstone ileus. This condition occurs when a gallstone enters the bowel through a biliary-enteric fistula, leading to mechanical obstruction.
A large gallstone (>2.5 cm) erodes through the gallbladder wall, creating a cholecysto-enteric fistula (most commonly into the duodenum).
The stone enters the bowel and may cause obstruction, most often at the ileocecal valve due to its narrow lumen.
The presence of air in the biliary tree (pneumobilia) results from communication between the biliary and intestinal tracts.
