Amoebic liver abscess (ALA) is a common extra-intestinal presentation of amoebiasis caused by Entamoeba histolytica . The liver abscess may be complicated by rupture into adjacent structures. Common organs involved include thorax, peritoneum and pericardium . Rupture into the gastrointestinal tract is extremely rare. We report a patient who developed a hepatoduodenal fistula complicating an amoebic liver abscess. Suspicions were raised on finding air in the liver abscess on ultrasound scanning. Diagnosis was confirmed on a water-soluble (Gastrografin) swallow (Fig. 1 a,b). Complications of ALA are associated with a high morbidity and mortality and early diagnosis is important. To our knowledge only one previous case of a hepatoduodenal fistula complicating an ALA with radiological confirmation has been reported .