26th April 2024

A 63-year-old man with a known history of choledocholithiasis presents with a sudden onset of severe right upper quadrant pain, high fever with chills, and jaundice.

A 63-year-old man with a known history of choledocholithiasis presents with a sudden onset of severe right upper quadrant pain, high fever with chills, and jaundice. He mentions that the pain occasionally radiates to his back. Over the past day, he has felt increasingly unwell and lethargic. On examination, his temperature is 38.7°C, and he appears jaundiced. Palpation of his abdomen reveals marked tenderness in the right upper quadrant.

Investigations:

Serum bilirubin: Significantly elevated

Alkaline phosphatase: Elevated

White blood cell count: Elevated 

Liver function tests: Abnormal liver enzymes

Which is the most likely diagnosis?