A 23-year-old patient presented to the emergency department of trauma center Civil Hospital Karachi with complaints of fever for two days and pain at the epigastric region and at the post-surgical site for three days, following a laparoscopic cholecystectomy performed five days prior. The pain started at the epigastric region radiating to the tip of shoulder and at the surgical site. The pain was sudden and sharp, aggravated by eating , and relieved with analgesics for few hours. However, since the last day, the pain had become more severe and was unrelieved by oral analgesics. The pain was accompanied by vomiting, which was non-projectile, with two episodes per day containing food particles and no associated bleeding. Fever was sudden in onset, intermittent, and undocumented, associated with chills and rigor. patient had undergone a laparoscopic cholecystectomy for chronic cholecystitis secondary to cholelithiasis five days prior to presentation and had no significant past medical history. At the time of presentation, the patient reported normal bowel and bladder movements and appetite.

On examination, the abdomen was soft, with tenderness at the epigastric and infraumbilical surgical site, a tympanic sound on percussion and normal bowel sounds were noted. All other systemic examinations were unremarkable. Except the patient had mild yellowish discoloration of sclera. On admission vitals were: temperature of 101°F, blood pressure of 97/63 mmHg, heart rate 100 bpm, breathing rate of 20 bpm, and saturation (SpO₂) 96% on room air. The patient weighted 56 kg and was alert and oriented to time, place, and person. Glasgow Coma Scale (GCS) revealed a score of 15/15.