Spontaneous Pneumobilia: Not So Benign

Pneumobilia is defined as air within the biliary system. It is usually caused by an abnormal connection between the biliary gastrointestinal tracts. Persistent asymptomatic pneumobilia is a rare occurrence and is generally considered a benign finding on imaging. Herein, we present a case of an 87-year-old male with long-standing pneumobilia of no identifiable cause who eventually developed Klebsiella cholangitis and bacteremia. In our report, we attempt to elucidate the causes of spontaneous pneumobilia and discuss its significance in the context of increased intraabdominal pressure.