Patient presented with postprandial right upper quadrant abdominal pain, bilious vomiting and constipation, concerning for small bowel obstruction. CT demonstrated pneumobilia, concerning for fistula between the gallbladder and duodenum. Also seen on CT was a calcified mass in the ileum with upstream dilation of proximal small bowel. This patient's presentation was consistent with the Rigler Triad and she was taken to surgery and they retrieved a 5 cm stone.

Acknowledgements: Case reviewed by and written in conjunction with radiology resident, Haziq Zahir, D.O.