An 82-year-old male patient with abdominal pain. Bloods revealed mildly deranged liver function tests with an obstructive pattern. US and MRCP showed intra- and extra-hepatic duct dilatation but no gallstones. An MDCT was performed to further assess the pancreas (Images 1a and b). The CT confirmed persistent mild biliary dilatation but no pancreatic mass. Blood cultures grew gram negative bacilli and a diagnosis of biliary sepsis was made. This was successfully treated with antibiotics.