Abstract
A 77-year-old man presented to our hospital with the chief complaints of abdominal pain and vomiting. Detailed examination revealed evidence of cholangitis and obstructive jaundice caused by a juxtapapillary diverticulum, and the patient was diagnosed as having Lemmel syndrome. Endoscopic retrograde cholangiopancreatography (ERCP) was performed, however, selective biliary cannulation was difficult because of the presence of two papillary diverticula. The patient improved with conservative treatment, and did not wish to undergo surgical treatment. Approximately 11 months later, recurrence of Lemmel syndrome was confirmed. The patient's condition improved again with the administration of antibiotics, however, he returned again approximately 1 month after discharge with the complaint of abdominal discomfort. Detailed examination revealed multiple stones in the common bile duct. The patient was diagnosed as having acute choledocholithiasis associated with Lemmel syndrome and was hospitalized for surgical treatment. Because papillary dysfunction was suspected, endoscopic sphincterotomy (EST) using the intraoperative rendezvous technique and endoscopic removal of the stones in the common bile duct were performed. The results indicated that EST using the intraoperative rendezvous technique is an effective method that provides good postoperative outcomes in cases of Lemmel syndrome with multiple stones in the common bile duct.
