This case takes place in Maine and involves a middle aged female patient with a past history of Crohn’s Disease and a surgical history of multiple prior abdominal surgeries. The patient underwent an elective procedure to remove a stone in her bile duct. The surgery was complicated by the patient’s anatomy, looping of the endoscope, and post sphincterotomy perforation and bleeding. Intraoperatively, the surgeon noted that he caused a small serosal tear adjacent to the sphincterotomy, and as a result attempts to extract the stone from the bile duct were abandoned. The operative notes state that the surgeon had perforated the patient’s duodenum during the surgery. Attempts at endoscopic closure were unsuccessful and the patient was taken emergently to the OR in order to repair the injury to the duodenum.