A case with Le㎜el's syndrome successfully treated with drainage and stenting via endoscopic retrograde cholangiopancreatography (ERCP)

Abstract

Case : An 86-year-old female was presented with flu-like symptoms for a month. A chest X-P revealed pneumonia which was treated with antibiotics. Laboratory examination showed elevated hepatobiliary enzymes, suggesting cholangitis. Endoscopic retrograde cholangiopancreatography (ERCP) revealed no choledocholithiasis, but a huge juxtapapillary duodenal diverticula (JPD) which was compressing the lower common bile duct. We diagnosed Lemmel's syndrome, and performed drainage via ERCP. Despite a needle knife endoscopic sphincterotomy, the patient continued to show elevated hepatobiliary enzymes. Accordingly, we treated her by placing a stent (7 Fr pigtail tail type) across the sphincter of Oddi. The stent was pushed along a guide wire through the cystic duct and then down the common bile duct. The patient did well post-operatively and was discharged. The stent was replaced 2 months later and removed 4 months later. The scintigraphy of the biliary tract revealed excellent drainage. Conclusion : Drainage and stenting via endoscopic retrograde cholangiopancreatography (ERCP) was effective treatment for Lemmel's syndrome