From the Research
Pneumobilia is a condition that requires thorough investigation to identify potentially serious underlying conditions, and treatment depends on the underlying cause rather than the pneumobilia itself. The presence of air or gas within the biliary tree (bile ducts) of the liver typically indicates an abnormal connection between the biliary system and the gastrointestinal tract, allowing gas to enter the bile ducts. Common causes include previous biliary interventions like ERCP (endoscopic retrograde cholangiopancreatography), surgical biliary-enteric anastomoses, gallstone ileus, and emphysematous cholecystitis 1, 2. In some cases, pneumobilia may result from a spontaneous fistula between the biliary system and adjacent bowel, often due to gallstones eroding through the gallbladder wall.
Diagnosis and Treatment
Diagnosis is typically made through imaging studies such as abdominal X-rays, ultrasound, CT scans, or MRI, where air appears as dark, branching patterns within the liver 3, 4. If associated with infection (cholangitis), antibiotics covering enteric organisms like E. coli, Klebsiella, and Enterococcus are necessary. Surgical intervention may be required for conditions like gallstone ileus or biliary-enteric fistulas. Importantly, while pneumobilia following biliary procedures is often benign, spontaneous pneumobilia without prior intervention warrants thorough investigation to identify potentially serious underlying conditions.
Surgical Approaches
In cases where surgical intervention is required, the approach may vary depending on the underlying cause. For example, in cases of gallstone ileus, a two-stage procedure (either enterotomy alone or enterotomy and subsequent cholecystectomy) has been shown to be associated with lower mortality rates 5. However, there is no general consensus on the gold standard surgical approach in these cases.
Key Considerations
- Pneumobilia can be a sign of a serious underlying condition, and thorough investigation is necessary to determine the cause.
- Treatment depends on the underlying cause, and may include antibiotics, surgical intervention, or other approaches.
- Spontaneous pneumobilia without prior intervention warrants thorough investigation to identify potentially serious underlying conditions.
- Surgical approaches may vary depending on the underlying cause, and a two-stage procedure may be associated with lower mortality rates in certain cases.