23rd April 2024

A 48-year-old female presents to the emergency department with abdominal pain and vomiting

A 48-year-old female presents to the emergency department with abdominal pain and vomiting. She has no significant past medical history aside from awaiting an elective laparoscopic cholecystectomy for recurrent episodes of biliary colic and two previous episodes of cholecystitis. On examination, her abdomen is soft but slightly distended. She is apyrexial.

Investigations show the following:

The abdominal ultrasound report is as follows:

“There is an impression of biliary dilatation and pneumobilia. The common bile duct measures 8mm (normal <6mm)”.

Chest x-ray report:

“No focal lung pathology. No air under the diaphragm.”

Abdominal x-ray report:

“Evidence of small bowel dilatation measuring up to 7mm.”

What is the most likely diagnosis?

Select the SINGLE most appropriate option from the list below. Select ONE option only.