title: 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.
authors.affiliation: Department of Surgery, Ziv Hospital Affiliated to the Faculty of Medicine in the Galilee, Bar Ilan University, Safed, Israel.
authors.forename: Raphael
authors.initials: R
authors.lastname: Fedidat
authors.affiliation: Department of Surgery, Ziv Hospital Affiliated to the Faculty of Medicine in the Galilee, Bar Ilan University, Safed, Israel Golan Polyclinic, Golan Heights, Israel.
authors.forename: Wajdi
authors.initials: W
authors.lastname: Safadi
authors.affiliation: Department of Surgery, Ziv Hospital Affiliated to the Faculty of Medicine in the Galilee, Bar Ilan University, Safed, Israel.
authors.forename: Igor
authors.initials: I
authors.lastname: Waksman
authors.affiliation: Department of Surgery, Ziv Hospital Affiliated to the Faculty of Medicine in the Galilee, Bar Ilan University, Safed, Israel.
authors.forename: Amram
authors.initials: A
authors.lastname: Hadary
mesh_terms: D000328:Adult; D000388:Air; D001658:Biliary Fistula / Q000150:complications / Q000000981:diagnostic imaging*; D001659:Biliary Tract / Q000000981:diagnostic imaging*; D002760:Cholangiopancreatography, Endoscopic Retrograde; D004378:Duodenal Diseases / Q000150:complications / Q000000981:diagnostic imaging*; D006801:Humans; D007412:Intestinal Fistula / Q000150:complications / Q000000981:diagnostic imaging*; D041781:Jaundice, Obstructive / Q000209:etiology; D008297:Male