A duodenal perforation is a serious complication that can occur during endoscopic retrograde cholangiopancreatography (ERCP), particularly if it is associated with therapeutic endoscopic sphincterotomy. Therefore, it is crucial to identify and manage it early to achieve the best possible outcome. Conservative management may be attempted; however, surgical intervention is required if signs of sepsis or peritonitis are present. In this case report, we present the case of post-ERCP duodenal perforation in a 33-year-old female with sickle cell disease who presented on account of abdominal pain. The patient was diagnosed with post-ERCP duodenal perforation, type 4 according to the Stapfer classification. She was subsequently treated conservatively with intravenous antibiotics, bowel rest, and serial abdominal exams. The patient noted significant interval improvement in symptoms and was subsequently discharged home. The early detection and management of suspected complications of ERCP provide a critical prognostic value.

Gangrenous cholecystitis is a potentially fatal complication of acute cholecystitis that presents with right upper quadrant pain and sepsis. Due to the overlap in clinical features with ascending cholangitis, gangrenous cholecystitis can be easily misdiagnosed, resulting in treatment delay. While the gold standard of diagnosis of gangrenous cholecystitis is direct visualization during surgery and tissue sampling to pathology, some imaging features can guide the diagnosis to appropriate early surgical treatment of gangrenous cholecystitis. A 78-year-old female presented to the emergency department with right upper quadrant pain, sepsis, and altered mental status. Imaging findings on ultrasound and CT were suggestive of gangrenous cholecystitis. However, clinically the patient presented with ascending cholangitis symptoms. Instead of an emergent cholecystectomy, percutaneous cholecystostomy (PTC) was performed. After the PTC, the patient worsened clinically and despite surgical intervention, the patient expired due to septic shock and multiple organ failure.