A 94 year old female with hx recent PE/DVT, atrial fibrillation, CAD presents with fever and abdominal pain.  Earlier, she presented with back pain and shortness of breath. She was found to have bilateral PE's and new afib and started on coumadin. Her HCT dropped slightly, requiring blood transfusion, with guaic positive stools. She was discharged and returned with abdominal cramping and black stools. EGD showed a small gastric and duodenal ulcer (healing), esophageal stricture, no active bleeding.  She also had an abdominal CT  demonstrating a distended gallbladder with gallstones and biliary obstruction with several CBD stones.