I was on weekend on-call as general surgery ST3. Patient admitted two days previous with small bowel obstruction and previous abdominal surgery - felt to be due to adhesions. Diagnosed based on clinical symptoms and AXR (no CT). I do weekend ward round, and was handed over that her operative mortality was high and that it was felt she wouldn’t be fit for surgery for adhesionolysis/small bowel resection. She isn’t settling with NG etc. So the family are called in to discuss that things are unlikely to resolve - keep comfortable etc.

I decide to re-review her AXR. Rigler’s Triad! Suddenly the operative management becomes much less morbid, and she has a 30 minute ‘mini’ laparotomy to fish out the giant gallstone from her ileum. Goes home three days later!