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#Acute

keywords: #Acute suppurative cholangitis, common bile duct, ERCP, cholangiogram, #stent. A 38-year-old lactating woman presented with severe epigastric pain that is referred to the back was admitted to the endoscopy unit. Abdominal ultrasound revealed gall bladder stones, diagnosed 4 years ago and dilated CBD with a stone in its lumen. Laboratory investigations showed leukocytosis, white blood cell count 12.4 × 103, normal range (4.3-10.8×103 ), international normalized ratio 1,32 (normal range 1-1.7 ), alanine aminotransferase 233, (normal up to 40 IU/L ), aspartate aminotransferase 398, (normal up to 40 IU/L ), lipase 40( normal below 60U/L ). The patient underwent endoscopic retrograde cholangiopancreatography. The scope revealed normally located papilla. Cannulation was done using an ERCP cannula, a cholangiogram revealed mildly dilated CBD. A wide sphincterotomy was done. The scope also showed an excessive amount of pus, whitish color coming out from the papilla denoting #acute suppurative cholangitis. Plastic stent 9×10 French was deployed into the CBD. Also, the stent opening showing pus coming out from the stent opening.