Unusual biliary gem: Cause of acute obstructive suppurative cholangitis and pancreatitis in a patient with Billroth II anastomosis

Abstract

A 72-year-old man with a 10-year history of subtotal gastrectomy with Billroth II anastomosis and laparoscopic cholecystectomy presented with abdominal pain, high fever and altered mental status. His blood pressure was 94/50mmHg, heart rate 136bpm and body temperature 39.4°C. Laboratory examination revealed the following: white blood cell count 16,200/μL; aspartate aminotransferase 418IU/L; alanine aminotransferase 160IU/L;