A rare case: Asymptomatic spontaneous pneumobilia
Pneumobilia, or aerobilia, is defined as the presence of gas in the biliary system. It may occur for various reasons, including recent enterobiliary system interventions, sphincter of oddi dysfunction, and enterobiliary fistula and anastomoses. A 61-year-old male patient presented to our emergency department due to nausea and vomiting. He had no history of drug use other than proton pump inhibitor medication, nor of alcohol or substance use. Although no history of previous medical intervention was present, gas (pneumobilia) was detected in the intrahepatic biliary ducts. We suspected that the incidentally detected pneumobilia in this patient, who also suffered from food poisoning, developed spontaneously in association with peptic ulcer and might have derived from a thin, asymptomatic enterobiliary fistula. Depending on its cause, pneumobilia may not require emergency surgery. The possibility of enterobiliary fistula should not be overlooked in patients presenting to the emergency department with chronic peptic ulcer symptoms.
Haouimi A, Gaillard F. Pneumobilia. Available from: https://radiopaedia.org/articles/pneumobilia
Yamashita H, Chijiiwa K, Ogawa Y, Kuroki S, Tanaka M. The internal biliary fistula-reappraisal of incidence, type, diagnosis and management of 33 consecutive cases. HPB Surg. 1997 June;10(3):143-7.
Lassandro F, Gagliardi N, Scuderi M, Pinto A, Gatta G, Mazzeo R. Gallstone ileus analysis of radiological findings in 27 patients. Eur J Radiol. 2004 Apr;50(1):23-9.
Rajković Z, Papes D, Altarac S, Arslani N. Abdominal pain and two x-rays: spot the difference. Ann R Coll Surg Engl. 2012 Mar;94(2):e95.
Lewandowski BJ, Withers C, Winsberg F. The air-filled left hepatic duct: the saber sign as an aid to the radiographic diagnosis of pneumobilia. Radiology. 1984 Nov;153(2):329-32.
Kane RA. Clue for distinguishing hepatic arterial calcifications from pneumobilia. J Clin Ultrasound. 2002 Sep;30(7):455.
Wu CC, Hung SF. Severe emphysematous pyelonephritis combined with pneumobilia. Emerg Med J. 2012 Nov;29(11):938.
Alvi AR, Zaidi M. A unique variant of intestinal tuberculosis. J Coll Physicians Surg Pak. 2008 Oct;18(10):657-9.
Antony A, Kramer S, Tzimas D, Saitta P. Pneumobilia Resulting From Choledochoduodenal Fistula Secondary to Metastatic Colon Adenocarcinoma. ACG Case Rep J. 2016 Jan;3(2):112-4.
Jabr FI. Large B-cell lymphoma of the duodenal papilla presenting as pneumobilia. Gastrointest Endosc. 2006 Oct;64(4):669-70.
Shirbur SN, Ramachandran H, Gokhale S, Falleiro J. Unusual Biliary Fistula. Med J Armed Forces India. 2001 Apr;57(2):167-8.
Okan I, Tali S, Özsoy Z, Deniz Ç, Acu B, Yenidoğan E, et al. The development of pneumobilia after blunt trauma. Ulus Cerrahi Derg. 2015 Jul;32(3):224-5.
Sandhu SS, Sampley SK, Chhabra K. Pneumobilia After Penetrating Trauma Abdominal Wall with no Injury to the Biliary Tree- A Case Report. Indian J Surg. 2013 Jun;75(Suppl 1):428-9.
Ladurner R, Kotsianos D, Mutschler W, Mussack T. Traumatic pneumobilia after cardiopulmonary resuscitation. Eur J Med Res. 2005 Nov;10(11):495-7.
Dutta U, Nagi B, Kumar A, Vaiphei K, Wig JD, Singh K. Pneumobilia--clue to an unusual cause of diarrhea. Trop Gastroenterol. 2002 Jul-Sep; 23(3):138-40.
Chaouch MA, Nacef K, Ghannouchi M, Khalifa MB, Chaouch A, Abdelkafi M, et al. Choledochoduodenal fistula due to peptic duodenal ulcer diagnosed by X-barium meal study: interest of medical treatment. Pan Afr Med J. 2018 Mar;29:177.
Abiad F, Sidani M. Biliary-colonic fistula through a cysticduct stump. Int Surg. 2000 Jul-Sep;85:231-3.
Çalışkan YK, Kalaycı MU. Can failure of choledochal cannulation in endoscopic retrograde cholangiopancreatography be prevented? J Surg Med. 2018 June;2(3):253-6.
Thyssen EP, Weinstock LB, Balfe DM, Shatz BA. Medical treatment of benign gastrocolic fistula. Ann Intern Med. 1993 Mar;118:433-5.
How to Cite
Copyright (c) 2019 Selman Yeniocak, Adem Az, Eda Canıpek, Büşra Ekinci Biçkici, Merve Metiner, Ahmet Demirel
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.