Gallstone ileus with Rigler’s triad in a 68-year-old male: An uncommon cause of intestinal obstruction

Gallstone ileus is a rare cause of mechanical bowel obstruction resulting from a gallstone migrating into the gastrointestinal tract through a biliodigestive fistula. It mostcommonly affects the distal ileum and is more prevalent in elderly patients. We present the case of a 68-year-old male with a history of hypertension who was admitted with vomiting and abdominal distension for 72 hours. CT imaging revealed pneumobilia, intestinal obstruction, and an ectopic gallstone, consistent with Rigler's triad. The gallstone, measuring 3 × 2 cm, was located 130 cm distal to the Treitz ligament. The patient underwent an emergency exploratory laparotomy with enterolithotomy, successfully removing the gallstone. Postoperatively, the patient recovered uneventfully, with complete resolution of symptoms. Gallstone ileus should be considered in elderly patients with intestinal obstruction, and early diagnosis using CT imaging is crucial for guiding treatment. Enterolithotomy remains the preferred surgical intervention with favorable outcomes in most cases.