Pneumobilia Resulting From Choledochoduodenal Fistula Secondary to Metastatic Colon Adenocarcinoma

Abstract

Pneumobilia, or air within the biliary tree, is a poor prognostic indicator in a patient without prior biliary sphincterotomy. Differential diagnosis includes infection with gas-forming organisms, choledochoenteric fistula in the setting of gallstones or penetrating ulcer disease, malignant invasion from a primary liver or biliary tract tumor, or metastatic disease. Treatment depends on etiology and patient factors, but often requires surgical intervention. We report a patient with gastrointestinal bleeding in whom pneumobilia was incidentally noted on abdominal plain film. Computed tomography and endoscopy revealed the biliary-enteric fistula to be caused by metastatic colon adenocarcinoma invading the biliary tree.

A Rare Presentation of Choledochoduodenal Fistula Due to Ovarian Cancer Metastasis

“…There have been a few reported cases of CDF from intrabiliary metastasis from distant organs such as adenocarcinoma of the colon. 4 Adenocarcinoma of the distal CBD 5 and intraductal papillary mucinous neoplasm of the bile duct 6 have also been known to cause a similar presentation of CDF. 5 Other malignancies including gallbladder cancer can also lead to a CDF.…”

A rare case: Asymptomatic spontaneous pneumobilia

“…It has been reported in association with emphysematous cholecystitis, emphysematous pyelonephritis, hepatic abscess, and intestinal tuberculosis [1,7,8]. Some case reports have shown that it can develop in association with metastatic colon cancer, as well as lymphoma, and may be associated with malignancy [9,10]. Gallstone is one important cause of pneumobilia, representing one in four bowel obstructions, and pneumobilia has been detected in 89% of these ileus cases [3].…”