A 65 years old female with no known comorbidities presented with history of on and off pain in right upper quadrant (RUQ) for 6 months. The pain was acute in onset, pricking in nature, aggravated by oily food and there was no radiation to other sites. She complains of nausea and anorexia following the initiation of RUQ pain. She had no significant past and family history. She did not consume alcohol and was a nonsmoker. On clinical examination, she was afebrile without any signs of jaundice. The patient was underweighted with a body mass index (BMI) of 18.1 kg/m2 (height:156 cm, weight: 44 kg). The abdominal examination showed tenderness in RUQ with no features of rebound tenderness, guarding and rigidity. During her initial laboratory evaluation, complete blood count, serum amylase, serum lipase and liver function test were withing normal range. The patient was advised for ultrasonography (USG) of the abdomen and pelvis which showed dilated common bile duct (CBD) which measured 1.2 cm with multiple distal echogenicity causing posterior acoustic shadow. A provisional diagnosis of uncomplicated choledocholithiasis was established and further surgical management was planned. The patient underwent open choledocholithotomy with CBD stenting and a T-tube was placed in the CBD. Intraoperative cholangiography was performed which confirmed absence of CBD stones. The patient was discharged on day 10 of admission with a healthy incisional wound, improving nutritional status (BMI: 20.3 kg/m2) and a T-tube in situ. She was advised to remove the T-tube after 2 weeks. She returned on day 30 following her operation for the removal of T-tube with a BMI of 16.8 kg/m2 (height: 156 cm, weight: 41 kg). Following 60 minutes of removing the T-tube, the patient developed acute agonizing pain in the right upper quadrant with radiation to the right shoulder. The pain was associated with nausea and multiple episodes of vomiting. On examination, the patient was ill-looking with tenderness in the RUQ along with board-like rigidity and rebound tenderness. Her bowel sounds were intact. Her initial blood parameters showed raised white blood cell with increased neutrophils and a significantly low platelet count of 60,000 (Normal: 150000–450000/mm3). Contrast enhanced computed tomography (CECT) abdomen confirmed the presence of fluid in the peritoneal and pleural cavity. Biliary peritonitis was suspected clinically and she was planned for emergency diagnostic laparoscopy. However, her condition deteriorated quickly making her unfit for any surgical procedures. She was admitted to the surgical intensive care unit (SICU) after a quick sepsis related organ failure assessment (qSOFA) scoring of 3/3 for constant monitoring of her vital parameters and blood investigation as shown in. A course of broad-spectrum antibiotics was initiated along with intravenous fluids to manage her ongoing losses. The bile was positive for Klebsiella pneumonia and Escherichia coli. Antibiotic courses were adjusted according to the culture and sensitivity. She was managed with a team of gastro-surgeons, critical care physicians, anesthesiologist and nurses. Despite the multimodal management, the patient went into septic shock with continued fall in mean arterial pressure (MAP) and increase in lactate levels on third of SICU admission. She was managed with crystalloid infusion and vasopressors for the following day. On Day 4, her sepsis worsened into multiple organ dysfunction syndrome following which she had a cardiopulmonary arrest that led to her mortality. The patient family member had signed a Do Not Resuscitate (DNR) request following her worsening conditions.