Gaduputi V, Tariq H, Rahnemai-Azar AA, Dev A, Farkas DT. Gallstone ileus with multiple stones: Where Rigler triad meets Bouveret’s syndrome. World J Gastrointest Surg 2015; 7(12): 394-397 [PMID: 26730285 DOI: 10.4240/wjgs.v7.i12.394]
Corresponding Author of This Article
Hassan Tariq, MD, Department of Medicine, Bronx Lebanon Hospital Center, 1650 Selwyn Ave, Suite #10C, Bronx, NY 10457, United States. htariq@bronxleb.org
Research Domain of This Article
Surgery
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastrointest Surg. Dec 27, 2015; 7(12): 394-397 Published online Dec 27, 2015. doi: 10.4240/wjgs.v7.i12.394
Gallstone ileus with multiple stones: Where Rigler triad meets Bouveret’s syndrome
Vinaya Gaduputi, Hassan Tariq, Amir A Rahnemai-Azar, Anil Dev, Daniel T Farkas
Vinaya Gaduputi, Hassan Tariq, Anil Dev, Department of Medicine, Bronx Lebanon Hospital Center, Bronx, NY 10457, United States
Amir A Rahnemai-Azar, Daniel T Farkas, Department of Surgery, Bronx Lebanon Hospital Center, Bronx, NY 10457, United States
Author contributions: All authors had made contributions to the article and have reviewed it before submission.
Institutional review board statement: This case report was exempted from our Institutional Review Board as per its policy.
Informed consent statement: Informed consent for participation was obtained from this patient.
Conflict-of-interest statement: None of the authors have any financial conflicts of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Hassan Tariq, MD, Department of Medicine, Bronx Lebanon Hospital Center, 1650 Selwyn Ave, Suite #10C, Bronx, NY 10457, United States. htariq@bronxleb.org
Telephone: +1-718-9601234 Fax: +1-718-9602055
Received: April 28, 2015 Peer-review started: April 30, 2015 First decision: August 4, 2015 Revised: September 17, 2015 Accepted: October 16, 2015 Article in press: October 19, 2015 Published online: December 27, 2015
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.
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.
