Lemmel Syndrome Presenting with Transient Cholangitis and Bacteremia: A Case Report

Lemmel syndrome is a rare disease characterized by mechanical obstruction of the bile duct secondary to a periampullary duodenal diverticulum. We present the case of a 74-year-old male patient admitted with generalized abdominal pain and fever. His initial blood work revealed derangement of liver function tests (LFTs) and leukocytosis. Imaging, including ultrasound and contrast-enhanced computed tomography (CECT) of the abdomen and pelvis, showed multiple gallstones without biliary dilation and ruled out any hepatobiliary obstruction and micro-abscesses. However, an upper gastrointestinal endoscopy identified a duodenal diverticulum. Given the patient's bacteremia and the presence of duodenal diverticula without any evidence of an obstructive cause, Lemmel syndrome with transient cholangitis was considered the most likely diagnosis. Unlike most published reports of Lemmel syndrome presenting with persistent obstructive jaundice, our case is distinctive in its transient presentation complicated by bacteremia, which posed diagnostic challenges and required multimodal imaging for confirmation.