Figure 1.

Urgent abdominal CT. Unenhanced images detect peripheral intrahepatic pneumobilia (arrowhead in a), overdistended stomach, and focal adhesion between posterior wall of the proximal duodenum and ventral aspect of the pancreatic head (thick arrow in b). After intravenous contrast administration, detailed oblique-reformatted image (c) shows thin fluid-like communication consistent with choledocho-duodenal fistula (arrow). No abnormalities were detected in the gallbladder. Three days later, during acute pancreatitis repeat CT (d) detects appearance of peripancreatic effusion, confirms fluid-containing fistulous track between the posterior duodenal bulb and the distal common bile duct (thin arrow)