Case contributed by RMH Core Conditions
Diagnosis certain


Lower abdominal pain.

Patient Data

Age: 90 years
Gender: Female

The cecum is dilated measuring up to 11.1 cm with large air fluid level. Air is seen throughout the remainder of the colon and down to the rectum. No dilated loops of small bowel identified. Pneumobilia is noted. 


There is sigmoid diverticular disease with mild fat stranding around the mid sigmoid. There is no extra luminal gas or collection. There is no free intraperitoneal fluid or gas. The bowel is non-dilated.

Pneumobilia and ductal dilatation.


Findings are most in keeping with sigmoid diverticulitis.

Case Discussion

Pneumobilia in this case is an incidental finding but should be differentiated from portal venous gas, which is much more concerning. Pneumobilia is most commonly from previous intervention such as a sphincterotomy. 

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