Imaging Case of the Week 580 Answer

The abdominal x-ray shows

  1. Dilated central small bowel loops.
  2. Branching gas pattern over the liver indicating the presence of pneumobilia.

The above two findings should raise suspicion for a gall stone ileus.

Gall stone ileus is a cause of small bowel obstruction in elderly patients. Rigler’s triad, which consists of three specific radiological signs, provides an indication of gall stone ileus:

  • Dilated small bowel loops (80%)
  • Pneumobilia (67%)
  • Calcified gall stone in an ectopic location, commonly in the distal ileum (50%)

Further reading: