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Obstruction of the bile and/or cystic duct, concomitant acute cholecystitis, extrahepatic bile duct necrosis, biliary stricture, and pancreatic choledochal fistula are possible biliary complications associated with AP [39–41]. CBD obstruction will commonly be seen as dilation of the CBD or cystic duct. CT imaging of cholecystitis demonstrates a distended gallbladder with an irregular wall. There may be biliary sludge and/or pericholecystic fluid [40]. Pancreatic choledochal fistulas occur as a result of direct inflammation and erosion between these two structures. CT scan of the abdomen with or without contrast shows a hypodense, thick fluid collection with gas in the pancreatic area [39].

Gastric, duodenal, jejunal, and colonic fistulization can also occur as a result of AP [42]. This occurs because of proteolytic enzyme autodigestion of the adjacent bowel from decompression of a pseudocyst or walled off necrosis as well as phlegmonous changes. The presence of gas on CT imaging may indicate fistulization [43].