The development of pneumobilia after blunt trauma

Vancomycin Treatment for Pneumobilia in Clostridioides difficile Infection: A Case Analysis

BACKGROUND Pneumobilia is the presence of air within the biliary tree. It is a relatively rare condition, usually caused by an abnormal communication between the biliary system and the gastrointestinal tract, or by infection from gas-forming bacteria. Antibiotic agents such as fluoroquinolones have many adverse effects, including Clostridioides difficile infection manifesting as colitis. Metronidazole has been used in the past and vancomycin and fidaxomicin can have good therapeutic results. CASE REPORT A 20-year-old man presented to Gennimatas General Hospital in Athens, Greece due to multiple episodes of diarrhea. He had received a 7-day treatment of oral levofloxacin, a common antibiotic treatment often used to treat Clostridioides difficile infection, until 10 days before presentation to our hospital as an outpatient treatment for mild pneumonia. Blood test revealed neutropenia and thrombocytopenia, and biochemical tests revealed hypokalemia and elevated inflammation markers. A CT scan of the abdomen showed pneumobilia. Blood and urine cultures were sterile, whereas Clostridioides difficile toxins A+ and B+ were detected in stool culture. Treatment with oral vancomycin had excellent results. The patient improved clinically and remained afebrile, with cessation of diarrhea, correction of electrolytic disorders, and disappearance of pneumobilia on a repeat CT scan after 1 week. CONCLUSIONS Pneumobilia caused by Clostridioides difficile infection was effectively treated with orally administered vancomycin, which cured our patient's diarrhea and pneumobilia.

Analysis of risk factors for infection after percutaneous biliary stenting in patients with cholangiocarcinoma and its impact on prognosis

Background

Cholangiocarcinoma (CCA) may invade the bile duct, causing malignant biliary obstruction, which is mainly treated by percutaneous biliary stenting. Biliary tract infection after stenting is a severe and common complication in the early postoperative period. In this study, we investigated the risk factors predisposing to infection after percutaneous biliary stenting in patients with CCA and its effect on prognosis. Our findings might reference early clinical prevention, diagnosis, and treatment.

Methods

We analyzed retrospective data regarding 337 patients who developed CCA and underwent percutaneous biliary stenting from December 2016 to December 2021. We collected the patients' general characteristics and clinical data utilizing a questionnaire regarding general information designed by the investigator. We performed the t-test and chi-square test to investigate the association between the clinical characteristics and postoperative infection and binary logistic regression to analyze the independent risk factors for patients developing postoperative infections. We used the Cox risk regression to determine each factor's effect on patients' survival status.

Results

Seventy-three cases of postoperative infection occurred in total, with an estimated infection rate of 21.7 %. Logistic regression analysis revealed that age [odds ratio (OR) =1.041, p =0.031], presence of combined gallstones (OR =2.200, p =0.030), stent type (OR =2.607, p =0.003), administration of preoperative prophylactic antibiotics (OR =0.473, p =0.042), presence of intraoperative complications of biliary bleeding (OR =2.452, p =0.017), presence of postoperative biliary pneumoperitoneum (OR =2.355, p =0.013), duration of surgery (OR =1.026, p =0.008), preoperative serum albumin (Alb) (OR =0.946, p =0.005), and preoperative hemoglobin (Hb) (OR =0.964, p =0.014) were the independent factors influencing postoperative infection development. The Cox risk regression analysis showed that infection occurrence was an independent factor influencing patients' survival time (OR =1.041, p =0.031).

Conclusion

Biliary tract infection is the most common complication after biliary interventions, and severe infection may even lead to death. Clinical studies should analyze and evaluate patients' clinical characteristics, perioperative indicators, and relevant serological indicators, identify relevant risk factors, and administer prompt treatment to reduce the chance of infection and improve patients' prognosis. HIPPOKRATIA 2023, 27 (2):89-98.

Spontaneous Pneumobilia: Not So Benign

Pneumobilia is defined as air within the biliary system. It is usually caused by an abnormal connection between the biliary gastrointestinal tracts. Persistent asymptomatic pneumobilia is a rare occurrence and is generally considered a benign finding on imaging. Herein, we present a case of an 87-year-old male with long-standing pneumobilia of no identifiable cause who eventually developed Klebsiella cholangitis and bacteremia. In our report, we attempt to elucidate the causes of spontaneous pneumobilia and discuss its significance in the context of increased intraabdominal pressure.