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RADPILES
CASES
QUIZ
QUESTION-1:
History of recurrent right upper quadrant pain:
Small bowel ischemia with portal venous gas
Pneumobilia
Status post ERCP
Correct Answer: Status post ERCP
Differential Diagnosis:
Enterobiliary instrumentation (ERCP)
Portal venous gas & bowel obstruction (ischemia)
Management:
Surgical:
Remove ectopic gallstone, cholecystectomy, biliary fistula excision if fistula present
Pearls:
Central hepatic gas (biliary), multiple air-fluid levels, round calcific density in small bowel
Rigler triad: Biliary gas, ectopic gallstone, bowel obstruction.
May see Rigler triad on plain radiograph.
Terminal ileum: most common
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