Pneumobilia

Abstract

Pneumobilia remains the most common finding associated with gallstone ileus and seen as a non-iatrogenic cause as a spontaneous biliary-enteric fistula in 90% of cases. This typically presents with an acute mechanical intestinal obstruction from a large gallstone lodged in the bowel lumen. Other causes of pneumobilia include emphysematous cholecystitis, incompetent sphincter of Oddi, biliary-enteric surgical anastomosis, cholangitis, liver abscess, blunt trauma, iatrogenic, post-ERCP and rarely from gallbladder cancer. Portal vein gas can appear similar on abdominal X-ray and should be differentiated as this is usually caused by mesenteric ischemia and is a surgical emergency associated with a mortality rate as high as 70%. This chapter describes the epidemiology and potential causes of pneumobilia as well as the diagnosis, complications and management of each etiology. It focuses on differentiating and adequately diagnosing between all potential causes and surgical management of gallstone ileus.

Until proven otherwise, small bowel obstruction and pneumobilia on a plain film is diagnostic of gallstone ileus