PMC4486403_01
Riglers triad.
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The abdominal X-ray revealed the presence of Rigler's triad (Fig. 1) confirmed in the abdominal CT (Fig. 2).
Gallstone.
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We then scheduled an emergency laparotomy, finding the site of obstruction at the rectosigmoid junction and extracting the stone with manual extrinsic pressure through the anus (Fig. 3).
Pneumobilia, Petrens sign (black arrow), gastro-jejunal fistula (arrowhead).
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To appropriately clarify the tract of the fistula, we performed a water-soluble contrast-enhance GI tract X-ray on the third postoperative day, which showed a gastro-choledochus and gastro-jejunal fistula (Fig. 4.).