Pneumobilia Pain - Symptoms, Causes, Treatment, Ultrasound

Pneumobilia is caused when an air bubble is entrapped in the biliary system. This can be diagnosed in the imaging studies e.g. magnetic resonance imaging, ultrasound and CT scan. Pneumobilia can be serious life threatening or simple self-limiting. The air bubble can cause an infection in the biliary duct. Due to the air bubble there is a hindrance in connection between intestine and bile duct. There may be some conditions associated with Pneumobilia like:

•    Spontaneous fistula in enteric-biliary duct
•    Surgical linking of biliary-enteric duct.
•    Sphincter of oddi (which control secretions) can be incompetent.
•    An infection in the bile duct.

Pneumobilia Causes:

Pneumobilia is caused by following conditions or factors:

•    The organism in our body which produces gas in the body can cause an infection in the bile duct         and may be called as emphysematous cholangitis
•    Pneumobilia can be due to an inherited abnormality.
•    Abscess formation in para duodenal.
•    Surgical trauma.
•    Cancerous cells in duodenum, bile duct and stomach.
•    Surgical biliary procedure e.g. biliary-enteric linking
•    Sphincter of oddi may be not good.
•    Gall stone ileus (fistula in enteric-biliary)
•    Duodenal tubing.
•    Bile duct may be rupture and let the air bubble travel towards the pancreas.
•    Incompetent sphincter of oddi can also cause chronic pancreatitis.

Pneumobilia Symptoms:

      
In Pneumobilia the patient can sometimes feel fever

•    Post prandial abdominal pain
•    Less food intake due to pain
•    Ultrasonography shows dilation of bile duct between liver and intestine
•    Gall bladder is not detected
•    There may be bouveret’s syndrome
•    Endoscopy may show gall stones in duodenal bulb
•    Due to chronic inflammation Local perforation of the gall bladder wall can occur
•    Local necrosis can occur.
•    Epigastric pain, nausea and vomiting can occur as visible symptoms.

Bilioenteric fistula can show no symptoms in 40 to 50% of cases but can show symptoms when the gall stones pass to duodenum from the gall bladder.

Pneumobilia Treatment

       
There have been only two ways of treatment in Pneumobilia

•    Endoscopic biliary procedure
•    Biliary surgery

In the 1st procedure, the patient swallow the endoscope and the physician will pass it through esophagus to the spot. Now a small plastic tube is inserted in the endoscope to view inside along with a dye. The dye will help to find the exact spot and the instruments will pass to fix if there is any obstruction or release the air bubble. Whereas in 2nd procedure the liver is connected to gastro intestinal tract. Due to air bubble obstruction the duct is bypass.

Pneumobilia Ultrasound:

Ultrasound is performed to confirm the:

•    Obstruction
•    Choledocholithiasis
•    Post-surgical problems
•    Gall bladder disease
•    Biopsy
•    Blockage of ducts or arteries and veins

The patient should not eat before ultrasound and should drink a lot of water for better results. Start with the supine of patient and access the pancreas. Now look clearly the common bile duct (CBD) located on the head of pancreas. Follow the common bile duct back to the liver to the point known as porta hepatis. Now measure the bile duct diameter arising from the liver. It is a painless procedure images are seen on computer attached.