BILIARY PNEUMATOSIS IN A PATIENT WITH CHOLANGITIS, A NOVEL FINDING

A 72-year-old man with secondary sclerosing cholangitis, cholecystectomy and Roux-en-Y hepaticojejunostomy, was admitted with a new episode of cholangitis. Percutaneous transhepatic cholangiography showed multiple strictures along the right and left intrahepatic ducts. Percutaneous radiological management failed because of impassable stenosis. Thereafter, an endoscopic duodenojejunostomy with a lumen apposing metal stent was performed. A calculus within the segment-III of the liver was removed. Endoscopy revealed submucosal blebs in the left intrahepatic duct. Some blebs were punctured with a sclerotherapy needle to confirm the presence of gas in the duct walls. Those gas-filled blebs were consistent with the novel finding: biliary pneumatosis.