An Unusual Case of Choledochoduodenal Fistula Secondary to Peptic Ulcer Presenting With Cholangitis and Pneumobilia

Choledochodoudenal fistula is an uncommon bilio-enteric with clinical presentation ranging from having no symptoms to frank cholangitis. The causes of choledochodoudenal are multiple, bile duct stones being the most common. Duodenal ulcer rarely source fistula. Clinical diagnosis defies acumen, and high-quality imaging including endoscopic or radiologic required for confirmation. Management not standardized remains challenging. We report unusual case a caused by duodenal that presented pneumobilia Treatment demanded medical, endoscopic, radiologic, and, ultimately, surgical intervention.