PMC5137637_01
Choledochoduodenal fistula: plain x-ray of the abdomen showing pneumobila (A), water soluble contrast study showing contrast leak from duodenum into biliary tract (B), oesophagogastroduodenoscopy showing duodenal lumen and choledochoduodenal fistula (C), and closer view of choledochoduodenal fistula (D)
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fig1
APD, an oesophagogastroduodenoscopy was performed, which found an ulcer in the first part of the duodenum (Fig 1). A diagnosis of a duodenal ulcer was made and he was given two-week course of Helicobacter pylori eradication therapy with omeprazole, clarithromycin and amoxicillin.  Pneumobilia was also demonstrated on plain x-ray of the abdomen (Fig 1). A repeat oesophagogastroduodenoscopy was performed and the fistula was clearly made out (Fig 1).
Histopathology of peritoneal nodule showing caseating granulomas
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fig2
On histopathology, the gallbladder showed chronic cholecystitis with intestinal metaplasia and the peritoneal nodules revealed caseation with epitheloid granulomas suggestive of TB (Fig 2). 