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The causes of pneumobilia include an incompetent Sphincter of Oddi (e.g. post sphincterotomy, or following passage of a gallstone), gallstone ileus, trauma, a duodenal ulcer perforating into the common bile duct, and secondary to surgery (e.g. cholecystoenterostomy).
In rare cases, pneumomediastinum may also arise as a result of blunt chest trauma (e.g. car accidents, fights, over pressure of breathing apparatus), while still evolving in the same fashion as the spontaneous form.