CASE PRESENTATION: A 66 year old man was admitted to the ICU for sepsis in the setting of abdominal pain and distension 1 day post cholecystectomy. He initially presented 2 months prior with cholecystitis and was successfully treated with antibiotics and a cholecystostomy tube. In the ICU he was treated with antibiotics and peritoneal drainage (bilirubin level of 49.5) after work up showed suprahepatic fluid collection. He was persistently febrile with ongoing output from peritoneal drain and developed worsening right pleural effusion. Thoracocentesis showed sterile exudative effusion with bilirubin of 3.1. Endoscopy with cholangiogram showed cystic duct bile leak, and a stent was placed shunting bile from the hepatic ducts to the common bile duct, bypassing the cystic duct. The patient’s abdominal distension improved soon afterward. He defervesced and imaging showed resolution of pleural effusion.