Peritoneal free air due to evacuation of pneumobilia in blunt abdominal trauma

Abstract

Pneumobilia is mostly observed on computed tomography (CT) following surgical biliary-enteric anastomosis and biliary manipulation through endoscopic procedures. Although pneumobilia can be seen in pathological conditions, post-surgical pneumobilia is typically not associated with morbidity. In the present article, we report a case in which blunt abdominal trauma led to the evacuation of pre-existing pneumobilia causing pneumoperitoneum. Given that the subsequent laparotomy proved to be non-therapeutic, this report adds to the few cases of intra-peritoneal free air not helped by surgical intervention.

Keywords: Pneumobilia; pneumoperitoneum; trauma.

Figure 1

CT scan of the abdomen prior to the patient’s current admission demonstrating pneumobilia but no intraperitoneal free air

Figure 2

CT scan of the abdomen on patient presentation demonstrating pneumobilia and pneumoperitoneum anterior to the liver

Figure 3

CT scan of the abdomen on post-operative day 9 demonstrating intra-hepatic abscess

Figure 4

CT of the abdomen prior to drain removal demonstrating both healing of the liver laceration and resolution of the intra-hepatic infection; however, pneumobilia persists