FIVE CASES OF PNEUMOBILIA : Duodenoscopic View

Abstract

Five cases of pneumobilia were presented. Fiberduo-denoscopy, hypotonic duodenography and blood che-mistry were performed in them and comparative studies were done. Case 1 : 68 year old male. In 1972, he visited our hospital due to postpr.andial pain.. Plain abdominall film showed pneumobilia. Upper-gatrointestnal series showed barium reflux into the bile duct and gastric ulcer on the posterior wall of the middle hotly. A fistula was found on the posterior wall of the duodenal cap. Case 2 : 56 year old male. In 1965, cholectstectomy with papilloplasty was performed because of choledo-cholithiasis. In 1972, he took part in photof luorography of a gastic mass survy and was suspected of having choledochoduodenal fistula. Hypotonic duodenography and endoscopy revealed a giant duodenal diverticulum and patent Vater's papilla with redness of the surro-unding mucosa. Case 3 : 65 year old female. In 1971 papilaoplasty was performed at a local hospital due to common bile duct dilatation. Plain abdominal film showed pneumobilia. Fiberscopy revealed patent Vater's papilla with redness and edma, but the biopsy specimen of Vater's papilla showed no particular findings. Case 4 : 39 year old male. In 1972, papilloplasty was perf omed due to chronic pancreatitis with papil-th is. Hypotonic duodenography revealed barium ref lux into the bile duct. Endoscopically, patent Vater's pa-pilla with redness and edema was recognized. Case 5 : 64 year old female. In 1972, she was admitted to our hospital for the control of diabetes, mellitus. Routine upper-gastrointestinal series and hypotonic duodenography revealed a duodenal diverticulum with barium ref lux into the bile duct, but no particular findings were noted on endoscopy. Summary; We presented five cases including one case of choledochoduodenal fistula and four cases of incom-petent sphincter of Oddi. There are few reports on their endoscopic appearance of Voter's papilla in the cases of pneumobilia or bihary tree on plain film of the abdomen and reflux of barum into the bile duct on hypotonic duodenogram. Encloscopic examination should be performed in those cases. Endoscopy is of great help for the diagnosis of duodenal fistula and incompetent: sphincter of Oddi.