Gallstone ileus with multiple stones: Where Rigler triad meets Bouveret’s syndrome

Figure 1 Scout film. Pneumobilia (dotted arrow) and ectopic gallstone (solid arrow). Marked gastric distention, with small bowel obstruction less clearly seen.

Figure 2 Pneumobilia clearly demonstrated.

Figure 3 Small bowel obstruction with multiple dilated loops with air fluid levels (dotted arrows), ectopic gallstones in left lower quadrant is seen (solid arrow).

Figure 4 Stone fragment in duodenum leading to gastric outlet obstruction (Bouveret’s syndrome).