抄録
A 60-year-old-man who had been diagnosed with Lemmel’s syndrome and treated by endoscopic sphincterotomy (EST) three years ago, was presented with a developing fever and epigastralgia. Laboratory data revealed elevated serum bilirubin, white blood cell count and C-reactive protein levels. A computed tomography (CT) scan and magnetic resonance cholangiopancreatography (MRCP) revealed that the lower part of the common bile duct was displaced by a parapapillary diverticulum and that the upstream was dilated, but choledocholithiasis was not evident. We therefore diagnosed a recurrence of Lemmel's syndrome. Despite conservative therapy, serum bilirubin and biliary enzyme levels were continuously elevated for ten days from the time of admission. Accordingly, we performed an additional EST for the purpose of improving jaundice and bile duct congestion. After the EST, serum bilirubin and biliary enzyme levels decreased to within normal range. The patient is presently doing well and has been free from a relapse for nine months.
An additional EST was effective against recurrent Lemmel’s syndrome.
