title: 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.
authors.affiliation: Department of Internal Medicine, New York University Medical Center, New York, NY.
authors.forename: Andrew
authors.initials: A
authors.lastname: Antony
authors.affiliation: Department of Medicine, Division of Gastroenterology, New York University Medical Center, New York, NY.
authors.forename: Scott
authors.initials: S
authors.lastname: Kramer
authors.affiliation: Department of Medicine, Division of Gastroenterology, New York University Medical Center, New York, NY.
authors.forename: Demetrios
authors.initials: D
authors.lastname: Tzimas
authors.affiliation: Division of Gastroenterology, Winthrop University Hospital, Mineola, NY.
authors.forename: Patrick
authors.initials: P
authors.lastname: Saitta