During hospital treatment in the same year, dilatation of ductus choledochus, 22 mm of the papilla of Vater with concrements within the lumen and aerobilia was verified, along with a 4-cm cystic formation covering ductus choledochus.
Ultrasound of the abdomen showed ductus choledochus of hyperechoic wall and enlarged spleen, along with pre-existing aerobilia of the bile ducts.
The classical radiologic triad or Riglers triad of pneumobilia, small bowel obstruction and ectopic gallstone is specific for this disease, is seen only in 9-14%. Plain abdominal radiographs may reveal signs of small bowel obstruction and concomitant aerobilia
to suggest the diagnosis.[5,6] Computed tomography is the investigation of choice as was seen in the reported case.
Although some medical centers make right diagnosis using advanced imaging (CT allows direct visualization of cholecystoenteric fistula) (6), in centers without this technology, the diagnosis is based on clinical suspicious (Rigler triad: airfluid levels, aerobilia
and radiopaque gallstone in atypical position) (7).
, at the Rx abdominal plain or CT, is a pathognomonic sign of biliary fistulas.