Rigler's sign
Hover on/off image to show/hide findings
Tap on/off image to show/hide findings
Rigler's sign
- If there is free intra-abdominal gas adjacent to a gas-filled loop of bowel then both sides of the bowel wall are well-defined. This is known as 'Rigler's sign'.
Rigler's sign
Hover on/off image to show/hide findings
Tap on/off image to show/hide findings
Rigler's sign
- The multiple loops of dilated gas-filled bowel indicate small bowel obstruction.
- Rigler's sign is visible, and so obstruction has been complicated by perforation.
- When gas surrounds multiple loops of bowel there may be formation of sharp points or triangles (arrowheads).
Rigler's sign
Hover on/off image to show/hide findings
Tap on/off image to show/hide findings
Rigler's sign
- Rigler's sign is often less obvious.
- This image shows a tiny triangle of gas outside the bowel, indicating pneumoperitoneum. Even this tiny volume of free gas is potentially life-threatening in the context of suspected perforation.
- If in doubt make sure there is a good quality ERECT chest X-ray available.
Rigler's sign - Chest X-ray
Hover on/off image to show/hide findings
Tap on/off image to show/hide findings
Rigler's sign - Chest X-ray
- If perforation is suspected an erect chest X-ray is more sensitive than an abdominal X-ray for detection of free gas.
- Occasionally Rigler's sign is visible on the erect chest X-ray. This image shows free gas under the diaphragm which outlines the outer side of the bowel wall.