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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