Choledochoduodenal fistula: an unusual case of pneumobilia

Abstract

Pneumobilia is the finding of air in the biliary tree. Most cases are iatrogenic in origin, especially after sphincterotomy and after hepaticojejunostomy or choledochojejunostomy. In patients without such history, the presence of pneumobilia needs further investigation. Most patients are likely to have an enterobiliary fistula. Although patients may be asymptomatic, possible complications include gallstone ileus, Bouveret syndrome or recurrent episodes of cholangitis. We present a case of a 38-year-old man presenting with obstructive jaundice and pneumobilia in whom choledochoduodenal fistula was diagnosed at endoscopic retrograde cholangiography. A description of different types of choledochoduodenal fistulas and management recommendations are also provided.

Peptic ulcer disease complicated with choledocho-duodenal fistula and gastro-intestinal bleeding: a case report and review of the literature

“…Most of entero-biliary fistulas and especially cholecysto-duodenal fistulas are caused by the present of gallstones, which induce inflammation, necrosis of the gallbladder or of the common bile duct wall and fistulisation into the adjacent organ ( 4 , 5 , 7 , 32 ). PUD of the duodenum is responsible for only 5%–6% of entero-biliary fistulas, but 75%–80% of CDF ( 32 , 33 ).…”

“…In our review, 54.5% of CDF cases were due to PUD. Two types of CDF are described in the literature: the proximal and the distal type ( 7 , 34 ). The proximal type is a single fistula, located more than 2 cm above the papilla and drains into the posterior wall of the duodenum ( 7 , 34 ).…”

An Unusual Case of Choledochoduodenal Fistula Secondary to Peptic Ulcer Presenting With Cholangitis and Pneumobilia

“…Diagnosing CDF mandates a high clinical suspicion and needs radiologic or endoscopic imaging to confirm. The presence of pneumobilia on plain X-ray, abdominal ultrasound, or CT scan should raise the suspicion of CDF; however, its presence is not universal [ 2 , 3 , 6 , 7 ]. EGD is another modality of investigation that can directly visualize the CDF and establish a cause such as PUD.…”

Choledocho-gastric fistula due to chronic peptic ulcer with gastric outlet obstruction and pneumobilia

“…Choledocho-gastric fistula has not been reported as a cause for pneumobilia 1 2. One case of choledochogastric fistula as an acute complication of peptic ulcer perforation has been reported in a 69-year-old man, wherein an antrectomy and fistula resection were performed 3.…”