A 38-year-old man presents to the emergency department 48 hours after undergoing ERCP with sphincterotomy for choledocholithiasis. He reports right upper quadrant pain, nausea, and dark urine. Temperature is 38.9°C, heart rate 102/min, blood pressure 128/82 mmHg, respiratory rate 18/min. Laboratory studies show total bilirubin 4.2 mg/dL, direct bilirubin 3.8 mg/dL, alkaline phosphatase 245 U/L, ALT 156 U/L, amylase 185 U/L, and white blood cell count 11,200/μL. Abdominal ultrasound demonstrates dilated intrahepatic bile ducts with a normal-caliber common bile duct and no stones. Blood cultures are pending. Which of the following is the most likely diagnosis?

1. A)Acute pancreatitis
2. B)Post-sphincterotomy papillary edema with transient obstruction
3. C)Acute cholecystitis
4. D)Ascending cholangitisGABARITO
5. E)Bile duct perforation