Rigler's triad

Last updated March 28, 2019

Rigler's triad is a combination of findings on an abdominal radiograph of people with gallstone ileus, a condition where a large gallstone causes bowel obstruction. Rigler's triad consists of: (1) small bowel obstruction, (2) a gallstone outside the gallbladder, and (3) air in the bile ducts.^[1] It bears the name of Leo George Rigler (1896–1979), who described it in 1941.^[2]^[3] It is not the same as Rigler's sign.

An abdominal x-ray is an x-ray of the abdomen. It is sometimes abbreviated to AXR, or KUB.

First described by Thomas Bartholin in 1654, gallstone ileus is a rare form of small bowel obstruction caused by an impaction of a gallstone within the lumen of the small intestine. Such a gallstone enters the bowel via a cholecysto-enteric fistula. The presence of large stones, >2.5 cm in diameter, within the gallbladder are thought to predispose to fistula formation by gradual erosion through the gallbladder fundus. Once a fistula has formed, a stone may travel from the gallbladder into the bowel and become lodged almost anywhere along the GI tract. Obstruction occurs most commonly at the near the distal ileum, within 60 cm proximally to the ileocecal valve. Rarely, gallstone ileus may recur if the underlying fistula is not treated.

Bowel obstruction, also known as intestinal obstruction, is a mechanical or functional obstruction of the intestines which prevents the normal movement of the products of digestion. Either the small bowel or large bowel may be affected. Signs and symptoms include abdominal pain, vomiting, bloating and not passing gas. Mechanical obstruction is the cause of about 5 to 15% of cases of severe abdominal pain of sudden onset requiring admission to hospital.

It is most commonly seen in 6th to 7th decade of life and affects females more often. Most patients with gallstone ileus are asymptomatic. Due to the fistula formation between the small intestine and gallbladder, large stones can lodge in the small bowel, leading to its obstruction. Pneumobilia means air in the biliary tract. It is due to the transfer of air from bowel through the fistula into the biliary tract.^{[ citation needed ]}

In medicine, a disease is considered asymptomatic if a patient is a carrier for a disease or infection but experiences no symptoms. A condition might be asymptomatic if it fails to show the noticeable symptoms with which it is usually associated. Asymptomatic infections are also called subclinical infections. Other diseases might be considered subclinical if they present some but not all of the symptoms required for a clinical diagnosis. The term clinically silent is also used.

The small intestine or small bowel is the part of the gastrointestinal tract between the stomach and the large intestine, and is where most of the end absorption of food takes place. The small intestine has three distinct regions – the duodenum, jejunum, and ileum. The duodenum is the shortest part of the small intestine and is where preparation for absorption begins. It also receives bile and pancreatic juice through the pancreatic duct, controlled by the sphincter of Oddi. The primary function of the small intestine is the absorption of nutrients and minerals from food, using small finger-like protrusions called villi.

A fistula is an abnormal connection between two hollow spaces, such as blood vessels, intestines, or other hollow organs. Fistulas are usually caused by injury or surgery, but they can also result from an infection or inflammation. Fistulas are generally a disease condition, but they may be surgically created for therapeutic reasons.

Related Research Articles

In vertebrates, the gallbladder is a small hollow organ where bile is stored and concentrated before it is released into the small intestine. In humans, the pear-shaped gallbladder lies beneath the liver, although the structure and position of the gallbladder can vary significantly among animal species. It receives and stores bile, produced by the liver, via the common hepatic duct and releases it via the common bile duct into the duodenum, where the bile helps in the digestion of fats.

Cholecystitis cholangitis that is characterized by an inflammation that is located in the gallbladder

Cholecystitis is inflammation of the gallbladder. Symptoms include right upper abdominal pain, nausea, vomiting, and occasionally fever. Often gallbladder attacks precede acute cholecystitis. The pain lasts longer in cholecystitis than in a typical gallbladder attack. Without appropriate treatment, recurrent episodes of cholecystitis are common. Complications of acute cholecystitis include gallstone pancreatitis, common bile duct stones, or inflammation of the common bile duct.

Cholecystectomy is the surgical removal of the gallbladder. Cholecystectomy is a common treatment of symptomatic gallstones and other gallbladder conditions. In 2011, cholecystectomy was the 8th most common operating room procedure performed in hospitals in the United States. Cholecystectomy can be performed either laparoscopically, using a video camera, or via an open surgical technique.

Abdominal pain, also known as a stomach ache, is a symptom associated with both non-serious and serious medical issues.

Gastrointestinal diseases refer to diseases involving the gastrointestinal tract, namely the esophagus, stomach, small intestine, large intestine and rectum, and the accessory organs of digestion, the liver, gallbladder, and pancreas.

Ileus Human disease characterized by impairment of intestinal peristalsis; in modern language usually excludes mechanical bowel obstruction

Ileus is a disruption of the normal propulsive ability of the intestine due to the malfunction of peristalsis.

A volvulus is when a loop of intestine twists around itself and the mesentery that supports it, resulting in a bowel obstruction. Symptoms include abdominal pain, abdominal bloating, vomiting, constipation, and bloody stool. Onset of symptoms may be rapid or more gradual. The mesentery may become so tightly twisted that blood flow to part of the intestine is cut off, resulting in ischemic bowel. In this situation there may be fever or significant pain when the abdomen is touched.

Gallbladder cancer is a relatively uncommon cancer, with an incidence of fewer than 2 cases per 100,000 people per year in the United States. It is particularly common in central and South America, central and eastern Europe, Japan and northern India; it is also common in certain ethnic groups e.g. Native American Indians and Hispanics. If it is diagnosed early enough, it can be cured by removing the gallbladder, part of the liver and associated lymph nodes. Most often it is found after symptoms such as abdominal pain, jaundice and vomiting occur, and it has spread to other organs such as the liver.

Pneumoperitoneum is pneumatosis in the peritoneal cavity, a potential space within the abdominal cavity. The most common cause is a perforated abdominal viscus, generally a perforated peptic ulcer, although any part of the bowel may perforate from a benign ulcer, tumor or abdominal trauma. A perforated appendix seldom causes a pneumoperitoneum.

A biliary fistula is a type of fistula in which bile flows along an abnormal connection from the bile ducts into nearby hollow structure. Types of biliary fistula include:

Ascending cholangitis bile duct disease that is an inflammation of the bile duct

Ascending cholangitis, also known as acute cholangitis or simply cholangitis, is inflammation of the bile duct (cholangitis), usually caused by bacteria ascending from its junction with the duodenum. It tends to occur if the bile duct is already partially obstructed by gallstones.

Biliary colic Medical condition in which gallstones cause acute pain

Biliary colic, also known as a gallbladder attack or gallstone attack, is when a colic occurs due to a gallstone temporarily blocking the cystic duct. Typically, the pain is in the right upper part of the abdomen. Pain usually lasts from one to a few hours. Often, it occurs after eating a heavy meal, or during the night. Repeated attacks are common.

The biliary tract, refers to the liver, gall bladder and bile ducts, and how they work together to make, store and secrete bile. Bile consists of water, electrolytes, bile acids, cholesterol, phospholipids and conjugated bilirubin. Some components are synthesised by hepatocytes, the rest are extracted from the blood by the liver.

Gallbladder diseases are diseases involving the gallbladder.

Cholescintigraphy or hepatobiliary scintigraphy is scintigraphy of the hepatobiliary tract, including the gallbladder and bile ducts. The image produced by this type of medical imaging, called a cholescintigram, is also known by other names depending on which radiotracer is used, such as HIDA scan, PIPIDA scan, DISIDA scan, or BrIDA scan. Cholescintigraphic scanning is a nuclear medicine procedure to evaluate the health and function of the gallbladder and biliary system. A radioactive tracer is injected through any accessible vein and then allowed to circulate to the liver, where it is excreted into the bile ducts and stored by the gallbladder until released into the duodenum.

References

↑ Clarke, Christopher (2015). Abdominal X-rays for Medical Students. John Wiley & Sons. p. 33.
↑ Rigler LG, Borman CN, Noble JF (1941). "Gallstone obstruction: pathogenesis and roentgen manifestations". Journal of the American Medical Association. 117: 1753–1759. doi:10.1001/jama.1941.02820470001001.
↑ Enersen, Ole Daniel. "Rigler's triad". WhoNamedIt.com. Retrieved 1 July 2015.

This page is based on this Wikipedia article
Text is available under the CC BY-SA 4.0 license; additional terms may apply.
Images, videos and audio are available under their respective licenses.

[1] Clarke, Christopher (2015). Abdominal X-rays for Medical Students. John Wiley & Sons. p. 33.

[2] Rigler LG, Borman CN, Noble JF (1941). "Gallstone obstruction: pathogenesis and roentgen manifestations". Journal of the American Medical Association. 117: 1753–1759. doi:10.1001/jama.1941.02820470001001.

[3] Enersen, Ole Daniel. "Rigler's triad". WhoNamedIt.com. Retrieved 1 July 2015.