Pneumobilia

Pneumobilia is the presence of gas in the biliary system. It is typically detected on a radiographic imaging exam, such as ultrasound, CT, or MRI. It is a common finding in patients that have recently undergone biliary surgery or endoscopic biliary procedure. While the presence of air within biliary system is not harmful, this finding may alternatively suggest a pathological process, such as a biliary-enteric anastomosis, an infection of the biliary system, an incompetent sphincter of Oddi, or spontaneous biliary-enteric fistula.

Pneumobilia
CT scan of pneumobilia

Causes

In a healthy individual with normal anatomy, there is no air within the biliary tree. When this finding is present, it may be secondary to:

  • Recent surgical or endoscopic biliary procedure (e.g. ERCP, biliary enteric anastomosis)
  • Incompetent sphincter of Oddi (e.g. passage of large gallstone, scarring related to chronic pancreatitis)
  • Spontaneous biliary enteric fistula (e.g. gallstone ileus)
  • Infection by gas-forming organisms (e.g. emphysematous cholangitis)
  • Congenital abnormalities

Other rare causes that have been reported include duodenal diverticulum, paraduodenal abscess, operative trauma, and carcinoma of the duodenum, stomach and bile duct.[1][2]

References
  1. Marshall SF, Polk RC. Spontaneous internal biliary fistula. Surg Clin North Am 1958; 38:679. PMID 13556568
  2. ReMine WH. Biliary-enteric fistulas: natural history and management. Adv Surg 1973;7:69. PMID 4591256

Further reading
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