From the Research
Pneumobilia is most commonly caused by a connection between the biliary tract and the gastrointestinal tract, with the primary causes including surgical interventions, pathological conditions such as gallstone ileus, and trauma to the biliary system. The causes of pneumobilia can be categorized into several key areas, including:
- Surgical interventions like biliary-enteric anastomoses and endoscopic retrograde cholangiopancreatography (ERCP) with sphincterotomy 1
- Pathological causes such as gallstone ileus, spontaneous biliary-enteric fistulas from peptic ulcer disease or malignancy, and emphysematous cholecystitis, an infection of the gallbladder with gas-forming organisms 2, 3
- Trauma to the biliary system, which can introduce air into the biliary tree 4, 1
- Incompetent sphincter of Oddi, which may allow reflux of intestinal gas into the biliary tree 5
- Gas-forming bacterial infections within the biliary system, which can produce pneumobilia without a physical connection to the gut 2
It is essential to note that while pneumobilia can be an incidental finding, it can also indicate serious underlying conditions requiring prompt evaluation, especially when accompanied by symptoms like abdominal pain, fever, or jaundice 3. The most recent and highest quality study, published in 2023, highlights the importance of considering traumatic etiology as a cause of pneumobilia, pneumoperitoneum, and pneumowirsung 1.
In terms of management, treatment depends on the etiology and patient factors, but often requires surgical intervention 3. However, in some cases, conservative management may be sufficient, as seen in the case report of a 75-year-old male patient who presented with pneumobilia, pneumoperitoneum, and pneumowirsung after closed thoraco-abdominal trauma and had a favorable clinical course after receiving conservative management 1.
Overall, the diagnosis and management of pneumobilia require a comprehensive approach, taking into account the underlying cause and the patient's overall clinical condition.