Endoscopic Management of Lemmel Syndrome Complicated by Duodenal Diverticulitis: A Case Report

TL;DR

A 62-year-old man with Lemmel syndrome and duodenal diverticulitis was successfully treated with endoscopic therapy, resolving his biliary obstruction and cholangitis.

Contribution

This case report highlights the effective endoscopic management of Lemmel syndrome complicated by duodenal diverticulitis.

Findings

Endoscopic retrograde cholangiopancreatography confirmed the diagnosis and guided treatment.

Sphincterotomy and biliary stent placement led to complete clinical and laboratory resolution.

Histopathology confirmed chronic inflammation of the periampullary mucosa.

Abstract

Lemmel syndrome is a rare cause of biliary obstruction resulting from the extrinsic compression of the distal common bile duct by a periampullary duodenal diverticulum in the absence of choledocholithiasis or malignancy. We present the case of a 62-year-old male patient with a history of hepatic steatosis and a recent laparoscopic cholecystectomy who was admitted with right upper quadrant pain and jaundice. Laboratory findings showed leukocytosis, cholestatic liver enzyme elevation, and hyperbilirubinemia consistent with severe cholangitis. Imaging revealed biliary ductal dilation without calculi or mass, and endoscopic retrograde cholangiopancreatography identified chronic inflammatory changes in the ampulla of Vater adjacent to a duodenal diverticulum. After performing a sphincterotomy and placing a biliary stent, the patient exhibited complete clinical and laboratory resolution. Histopathology confirmed chronic inflammatory changes of the periampullary mucosa. Endoscopic retrograde cholangiopancreatography continues to be the gold standard for both diagnosis and treatment. Individualized management is essential, and endoscopic therapy offers excellent results in properly selected patients.

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