Spontaneous pneumobilia from duodenal B-cell lymphoma

Ashish Padnani, Darshak Shah, Talat Addasi. New York Hospital Queens.

Pneumobilia occurs due to abnormal connection between gastrointestinal tract and biliary system, frequently requiring surgical intervention. There have been very few cases reporting spontaneous pneumobilia from duodenal lymphoma.

We report a case of 74 year old male who presented with abdominal pain, nausea and vomiting for few days. Patient underwent CT scan of abdomen/pelvis that showed gastric outlet obstruction from thickening of second portion of duodeum and spontaneous pneumobilia. Upper endoscopy showed mass lesion of second part of duodenum. The patient underwent gastrojejunostomy and choledochojejunostomy. Operative cholangiogram showed narrowing at the level of ampulla. Pathology showed B-cell lymphoma involving the ampulla. He was treated with post-operative chemotherapy and did well.

We did extensive literature search on this and found very few case reports on duodenal B-cell lymphoma manifesting as spontaneous pneumobilia.

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