A 78-year-old man was admitted to our hospital with complaint of right hypochondralgia. Laboratory data showed the elevation of transaminase and biliary tract enzymes. Abdominal CT showed stones in the common bile duct (CBD) and gallbladder (GB) . In addition, significant amount of gas was present in the bile duct while the gas in the GB was much less. Therefore the diagnosis of as acute cholangitis (Grade III) with pneumobilia was made. Endoscopic retrograde cholangiography (ERC) and ENBD were performed. Endoscopic view and ERC showed no evidence of choledochoduodenal fistula as the cause of pneumobilia. After the procedures, the patient’s symptoms disappeared. After a week, endoscopic sphincterotomy and lithotripsy were carried out. Bile culture was positive with Clostridium perfringens thus we concluded the acute cholangitis (Grade III) with pneumobilia was accounted for by the gas-producing Clostridium perfringens.
