{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,20]],"date-time":"2026-04-20T05:53:48Z","timestamp":1776664428617,"version":"3.51.2"},"reference-count":22,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,4,20]],"date-time":"2026-04-20T00:00:00Z","timestamp":1776643200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Surg."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>A 38-year-old woman with a 32-year history of recurrent biliary stones (cholecystectomy at age 6 and open choledochotomy with 6-month T-tube indwelling at age 16) presented with 2\u2005h of postprandial right upper quadrant pain. Laboratory tests showed mild hyperbilirubinemia (total bilirubin 24.4 \u03bcmol\/L, direct bilirubin 8.4 \u03bcmol\/L) and elevated alanine transaminase of 287 U\/L. Abdominal CT scan revealed common bile duct (CBD) stones without pneumobilia. Her symptoms resolved spontaneously before scheduled endoscopic retrograde cholangiopancreatography (ERCP). ERCP showed compensated dilatation of the CBD without residual stones, inadvertent contrast overflowing into the duodenum, a 5-mm choledochoduodenal fistula in the proximal descending duodenum, and a slender distal CBD segment confirmed by intraductal ultrasound. The fistula, further confirmed by enhanced CT, acted as a benign physiological drainage pathway. The slender distal CBD formed a specific pressure gradient, and spontaneous stone passage was achieved via this fistula, which was the core mechanism for the patient's long-term symptom-free survival.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Choledochoduodenal fistula can, in rare circumstances, exert a protective rather than deleterious effect in patients with cholelithiasis. This case with a benign clinical course complements the clinical scenario beyond the conventional clinical paradigm that choledochoduodenal fistulas commonly require active intervention.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fsurg.2026.1752034","type":"journal-article","created":{"date-parts":[[2026,4,20]],"date-time":"2026-04-20T05:24:44Z","timestamp":1776662684000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Choledochoduodenal fistula paradoxically prevents biliary obstruction: a case report"],"prefix":"10.3389","volume":"13","author":[{"given":"Chengzhen","family":"Lyu","sequence":"first","affiliation":[{"name":"Department of Gastroenterology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College","place":["Beijing, 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