Correspondence to Author: Owen Alsulaibi ^1,2, David Swartz³ , David Abi-Hanna¹. 

1. Department of Gastroenterology and Hepatology, Liverpool Hospital, Sydney, New South Wales, Australia.
2. South Western Sydney Clinical School, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia.
3. Department of Gastroenterology and Hepatology, Wollongong Hospital, Wollongong, New South Wales, Australia.

DOI: 10.52338/cicasrep.2026.5836

Abstract:

Lemmel’s syndrome is a rare cause of obstructive jaundice resulting from compression of the common bile duct by a periampullary duodenal diverticulum (PAD) in the absence of choledocholithiasis or malignancy, usually with food impaction. We report the case of a 78-year-old woman presenting with fever, right upper quadrant pain, and markedly elevated transaminases suggestive of hepatocellular injury. Initial CT imaging demonstrated a distended PAD causing biliary compression. ERCP was attempted following clearance of the PAD from impacted food. Cannulation was unsuccessful due to an intradiverticular papilla, despite 2 separate attempts at cannulation including a needle knife papillotomy. Subsequent endoscopic ultrasound confirmed biliary dilation with tapering at the ampulla and absence of choledocholithiasis. The patient improved on intravenous antibiotics following PAD clearance despite failed bile duct cannulation attempts. To our knowledge, this case represents the most severe transaminitis reported in Lemmel’s syndrome and reinforces the importance of including it in differential diagnoses for cholangitis with atypical liver biochemistry, particularly when imaging reveals periampullary diverticula.

Keywords: Lemmel’s syndrome; periampullary diverticulum; transaminitis; endoscopic retrograde cholangiopancreatography; food impaction; biliary obstruction.

Citation:

Dr. Owen Alsulaibi, Endoscopic Clearance Of An Impacted Periampullary Diverticulum In Lemmel’s Syndrome Presenting With Severe Transaminitis: A Case Report. Japanese Journal of Gastroenterology 2026.