COMMON BILE-DUCT - Obstruction

This shows a thickened and somewhat distended gallbladder; the common bile duct and cystic duct have been opened; the common duct is dilated and obstructed at its distal end by a gallstone.
This man was admitted at the age of 81 with right-sided abdominal pain and shortness of breath. His temperature was raised, and he was tender in the right hypochondrium. Investigations showed a white count of 13,300 differential count 91% neutrophils, and sedimentation rate 35 mm/hr. Total bilirubin 114 uMol/litre, alk.phos. 220 U/litre, gamma glutamyl transferase 490 U/litre, aspartate amino transferase 132 U/litre and alanine amino transferase 7 U/litre. Hepatitis-associated antigen negative. Blood culture grew E.coli.