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Presentation An elderly woman with multiple medical problems [including jaundice due to advanced pancreatic head malignancy] presented with pain in the right upper quadrant. A day later, she complained of high grade fevers and had elevated white cell count. An ultrasound performed one week prior to her current complaints showed calculi in the gallbladder with normal wall thickness. The patient had biliary dilatation with a common bile ductal stent in situ.
 
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