PREOPERATIVE DIAGNOSIS OF GALLSTONE ILEUS USING COMPUTED TOMOGRAPHY AND RIGLER'S TRIAD: A CASE REPORT

Abstract

Gallstone ileus is a rare complication of cholelithiasis caused by the migration of gallstones into the gastrointestinal tract through a bilioenteric fistula, resulting in mechanical bowel obstruction. This study aimed to report a case diagnosed preoperatively by computed tomography and treated with isolated enterolithotomy. A 51-year-old woman with a history of symptomatic cholelithiasis presented with a four-day history of intestinal obstruction. Abdominal computed tomography demonstrated bowel dilation, pneumobilia, and an ectopic intraluminal gallstone, allowing diagnosis based on Rigler's triad. Exploratory laparotomy revealed an approximately 5 cm gallstone impacted in the small intestine, which was removed through enterotomy followed by transverse closure. Cholecystectomy and bilioenteric fistula repair were not performed because of severe local inflammation. The postoperative course was uneventful, and the patient was discharged without complications. Early diagnosis using computed tomography and individualized surgical management are essential to improve outcomes in patients with gallstone ileus.