PMC6139465_01
CT abdomen showing the classical Rigler's triad of GSI. The red arrow indicates the ectopic gallstones. The blue arrow indicates the pneumobilia. Also, notice the dilated small bowel loops.
gr1.jpg
PMC6139465_01_gr1.jpg
fig0005
Contrast enhanced CT abdomen showed the classical Rigler's triad of GSI (Fig.1).
Intraoperative findings. A: Impacted gallstones were located using atraumatic clamps, B: Applying stay sutures for facilitation of bowel manipulation, C: Extraction of gallstones through enterotomy; notice the gallstones over the gauze and inside the bowel lumen, D: Closure of enterotomy transversely using Endo-stitch.
gr2.jpg
PMC6139465_01_gr2.jpg
fig0010
An atraumatic clamp was used to locate the impacted stones (Fig. 2A). After application of two stay sutures using 2/0 vicryl (Fig. 2B), a 3-cm longitudinal enterotomy was made just proximal to the stones (Fig. 2C). The enterotomy was closed transversely by continuous 2/0 vicryl on endo-stitch (Fig. 2D).