Air or gas may be seen in the biliary system on imaging studies or encountered during surgery. The significance depends on identifying the cause,
Sources of air or gas:
(1) infection with a gas forming bacteria (emphysematous or gangrenous cholecystitis due to Clostridium or other bacteria)
(2) fistula
(3) iatrogenic (during ERCP or other procedure)
A fistula may exist between the biliary system and:
(1) the stomach
(2) the duodenum
(3) other portions of the small bowel
(4) the colon (for the gallbladder)
(5) a bronchus (for the common bile duct)
Causes of a fistula:
(1) chronic cholelithiasis with cholecystitis
(2) cancer
(3) inflammatory bowel disease
(4) parasitic disease (echinococcosis, amebiasis)
(5) trauma
(6) abdominal surgery or endoscopic procedure
A patient with a choledochobronchial fistula may produce a bilious sputum.
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Specialty: Gastroenterology, Surgery, general
