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Gallstone ileus is a rare complication of cholelithiasis, characterized by mechanical bowel obstruction due to a biliary calculus originating from a bilioenteric fistula. The Rigler triad, consisting of aerobilia, ectopic gallstone, and intestinal obstruction, is rarely observed in its complete form. We present the case of a 92-year-old male with a history of acute lithiasic cholecystitis who presented to the Emergency department with acute epigastric pain. Initial evaluation revealed gallbladder dilatation, gallstones, and gallbladder wall thickening suggestive of acute cholecystitis. During hospitalization, the patient experienced an episode of hematemesis, leading to the diagnosis of a cholecystoduodenal fistula and a large blood clot in the duodenal bulb. Further imaging showed an ectopic gallstone causing small bowel obstruction. The patient underwent urgent surgery for stone extraction, followed by endoscopic intervention for the bleeding vessel identified at a subsequent gastroscopy. Unfortunately, the patient had a poor postoperative course and passed away seven days later. This case report highlights the exceptional occurrence of both the Rigler triad and upper gastrointestinal bleeding in a patient with gallstone ileus. Surgical intervention is crucial for the initial resolution of intestinal obstruction, followed by cholecystectomy and repair of the bilioenteric fistula. Awareness of these rare presentations is important for timely diagnosis and appropriate management of this uncommon complication of cholelithiasis.

Gallstone ileus is a rare complication of cholecystoduodenal fistula. Gastric ischemia due to intestinal obstruction is an extremely rare event that, if not diagnosed in time, can have a fatal outcome. We present the case of a patient with intestinal occlusion due to a gallstone obstructing the middle jejunum in which gastric ischemia was diagnosed intraoperatively due to the distension caused by the intestinal obstruction.

The duodenum is an uncommon location of diverticula in the digestive tract, and they are often asymptomatic. Formation of an enterolith inside diverticula has been previously described, although it is a rare condition. In this context, intestinal obstruction due to distal migration of foreign bodies is extremely rare. We report a case of an 86-year-old woman with obstructive symptoms due to a jejunal foreign body that had migrated from a duodenal diverticulum. An emergency laparotomy was performed to extract a phytobezoar. Enterolith ileus secondary to duodenal diverticula is an exceptional entity. Diagnosis and management are usually delayed because of a non-specific presentation, and early surgical exploration is required for bowel disimpaction. This condition should be considered in elderly patients with prolonged immobilization or neurodegenerative diseases.

Gallstone ileus is an exceptional complication among billiary diseases. It is defined as an intestinal obstruction caused by a gallstone as it passes through a bilio-digestive fistula. This is disease with high morbi-mortality, and whose main contributing factors are the advanced age of the patients, comorbidities and the delayed diagnosis. Most of the times, it is a postoperative diagnosis and a high clinical suspicion is essential for an early diagnosis. In patients with gallstone ileus the abdominal X-ray is frequently nonspecific and to observe a complete Rigler triad is exceptional.