A 64-year-old Asian female was admitted with a 3-day history of subjective fever, abdominal pain, nausea, and vomiting. On admission, the patient was febrile with mild abdominal tenderness on exam. Her lab values were significant for leukocytosis and abnormal liver function tests suggestive of a cholestatic pattern. Initial ultrasound showed a dilated common bile duct measuring 9mm and no evidence of gallstones, choledocholithiasis, or pancreatitis. The patient was admitted to the hospital with a diagnosis of systemic inflammatory response syndrome and started on intravenous antibiotics.