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A 65-year-old woman was admitted with a chief complaint of fever and abdominal pain. The patient had severe abdominal pain with abdominal guarding, and a fever of 38.5°C. The patient had diarrhea, abdominal pain, and fever for 2 days before the presentation. Her medical history was significant for pulmonary tuberculosis about 45 days earlier. She had also undergone endoscopic retrograde cholangiopancreatography(ERCP) a month earlier because of choledocholithiasis, and a 10-cm biliary stent was inserted for her. The patient also had a history of two abdominal surgeries many years ago but could not remember the reasons. The evaluation of vital signs in the emergency room showed a temperature of 38.5°C, pulse rate=98 beats per minute (bpm), respiratory rate=17 breaths per minute, and blood pressure=125/86 mmHg.  An abdominal examination revealed a distended, tender abdomen. The rest of the physical examination was unremarkable. Laboratory data showed hemoglobin=10.7 g/dL, white blood cell (WBC) count=18300 mm 3 (with 89% predominant neutrophils), platelet count=450,000 mm 3 , sodium=136 mmol/L, potassium=4.2 mmol/L, blood urea nitrogen=28 mg/dL, and creatinine=1.92 mg/dL. The patient underwent abdominal computed tomography (figure 1) with showed evidence of peritonitis.

Acute Abdomen in a Patient with a History of Pulmonary Tuberculosis and Endoscopic Retrograde Cholangio-Pancreatography Due to Common Bile Duct Stones