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.
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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.
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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


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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


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