Epigastric pain, vomiting. Clinical signs of peritonitis. Labs: leukocytosis with neutrophilia; total bilirubin 2.1 mg/dL; amylase 2101 IU/L, lipase 6946 IU/L; C-reactive protein  2.37 mg/L (normal). Bedside ultrasound showed a gallbladder with a thickened wall and tiny gallstones, some of them floating. CT abdomen showed signs of interstitial edematous pancreatitis and a gallbladder containing tiny floating gas-density cholesterol gallstones.