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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).
The most common cause of a spontaneous pneumoperitoneum is the introduction of air through the female genital tract (see the images below). Pneumoperitoneum. Upright chest radiograph shows a large pneumoperitoneum outlining the spleen and the superior surface of the liver.