Localised pneumoperitoneum following liver mass biopsy in the setting of post-ERCP pneumobilia

Description

A 72-year-old woman presented with a 1-week history of fatigue, weight loss and painless jaundice. Liver chemistries confirmed cholestasis with hyperbilirubinaemia of 25.6 mg/dL. An abdominal CT scan revealed multifocal liver lesions and dilation of intrahepatic and extrahepatic bile ducts. On endoscopic retrograde cholangiopancreatography (ERCP), a common bile duct stricture was found requiring dilation and insertion of a biliary stent. Cholangiogram demonstrated free bile drainage without contrast medium leakage. The patient then underwent CT-guided biopsy of a left lobe liver mass. On the next day, she complained of constant abdominal pain. She was afebrile and there were no peritoneal signs. Abdominal CT scan demonstrated localised free air in the peritoneal cavity (figure 1). The stent was at the proper position and pneumobilia of the common bile duct and intrahepatic bile ducts was noted. The occurrence of free air in the peritoneal cavity post-ERCP raised significant concerns...

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