You are the SpR attending to a patient who had a cholecystectomy. On POD-2, the patient experiences worsening abdominal pain and tachycardia. You conduct some tests and discover that the patient has a WCC of 18, CRP of 50, and elevated bilirubin. An ultrasound reveals free fluid in the abdomen and no CBD dilatation. You report this to your consultant, who suspects a bile leak from CBD injury.

Your consultant wants you to transfer the patient to HPB consultant Prof Archibald at the regional center. However, the consultant's reg is not happy that the labs are from yesterday.

• Present your case
• What do you think is the source for the bile leakage?
• Why do you think her CRP is raised? Is there an infection?
• When were those blood samples taken? OR were any blood samples taken today?
• What will be your management?
• What does ERCP stand for and what does it involve?
• Is this urgent?
• Who do you need to speak to in order to arrange the transfer?
• What is biliary peritonitis?
• There are no beds available at this hospital at the moment. How do you think we should proceed?