Gastroenterology clinical image challenge: An 85-year-old woman with a history of nonsteroidal anti-inflammatory drug and chronic alcohol use presented with epigastric abdominal pain, melena and nausea with nonbloody emesis. On physical examination, she was afebrile with mild epigastric tenderness but no guarding. Laboratory values were notable for a hemoglobin of 8.6 g/dL. Abdominal computed tomography scanning showed pneumobilia (figure), but no other biliary or pancreatic abnormalities. She had no prior history of biliary interventions.
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