Biliary phytobezoar resulting in intestinal obstruction

Figure 1 Development of a biliary phytobezoar in the extrahepatic bile duct. A: Axial portal venous-phase computed tomography (PVP CT) 3 years ago showing diffuse bile duct dilatation (white arrow) with pneumobilia; B: On endoscopic retrograde cholangiopancreatography, there was no abnormal filling defect except pneumobilia (red arrow) in the dilated extrahepatic bile duct (EHD). A choledochoduodenal fistula (white arrow) in the distal common bile duct which was cannulated by endoscopy; C and D: Axial PVP CT and its coronal reformatted image at 6-mo follow-up showed a dilated EHD and a newly developed intraductal ovoid mass with interstitial air (red arrows), as well as the choledochoduodenalfistula (white arrow).