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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 disorder is also known by the name Mediastinal emphysema. Both types result from events that cause air to escape from lungs, bowel or airways into the chest cavity. A blunt blow or a penetrating chest trauma, iatrogenic injury or esophageal perforation can cause serious and traumatic pneumomediastinum.