Riglers triad is seen in

Ans. is 'a' i.e., Gall stone Ileus Gall Stone Ileus* This type of obstruction tends to occur in the elderly secondary to erosion of a large gallstone through the gall bladder into the duodenum.* Classically, there is impaction about 60 cm proximal to the ileocaecal valve.* The patient may have recurrent attacks as the obstruction is frequently incomplete or relapsing as a result of a ball-valve effect.* The classical radiological sign of gall stone obstruction is Rigler'straid consisting of small bowel obstruction, pneumobilbia and atypical mineral shadow on radiographs of the abdomen.* Presence of two of these signs is considered pathognomic for intestinal obstruction and is present in 40 - 50% of gall stone ileus patients.* At laparotomy it may be possible to crush the stone within the bowel lumen, after milking it proximally. If not, the intestine is opened and the gallstone removed. If the gallstone is faceted, a careful check for other enteric stones should be made.* The region of the gall bladder should not be explored.