A 52-year-old female with past medical history of moderately differentiated metastatic squamous cell carcinoma of the gallbladder presented to our institution with concerns for biliary obstruction and suspected cholangitis. The patient underwent an ERCP a few weeks prior for new onset obstructive jaundice. This revealed a malignant hilar stricture that was confirmed metastatic squamous cell carcinoma on brushings. The patient subsequently underwent plastic biliary stent placement. On this particular admission there was concern for stent occlusion and impending cholangitis. The patient was admitted to the MICU and was started on antibiotics with plans for a repeat ERCP on the day of admission.