Question: A 53-year-old man was admitted to the emergency department with 1 week of abdominal pain. The patient described sharp, severe right upper quadrant pain that worsened over 1 day. He reported a similar episode for which he underwent cholecystectomy in 2009. Vital signs were normal. Physical examination revealed tenderness over right upper quadrant. Laboratory work showed total bilirubin 3.5, aspartate aminotransferase 369, alanine aminotransferase 679, and alkaline phosphatase 260. Right upper quadrant ultrasound revealed common bile duct of 8 mm without any evidence of stones.