A case of Lemmel's syndrome treated by endoscopic removal of a food residue from a diverticulum

A case of Lemmel's syndrome caused by food impaction in a juxtapapillary diverticulum was reported. The patient was a 58-year-old femele admitted to our hospital with complaints of right upper abdominal pain. MRCP showed the common bile duct obstruction by a large juxtapapillary diverticulum with massive contents. Endoscopic examination showed the juxtapapillary diverticulum filled with a food residue. There were no gallstones or other potential causes of obstruction. After endoscopic removal of a food residue using forceps, symptoms disappeared immediately. Endoscopic examination after treatment showed a bleeding ulcer caused by a massive food residue in the bottom of the large diverticulum. Follow-up MRCP 8 days after endoscopic treatment showed normal-caliber common bile duct. Follow-up endoscopy about 2 months after the treatment showed the intradiverticular ulcer scar. During 2 years of follow-up, this patient had no recurrent symptoms. MRCP was safe and effective for early diagnosis of Lemmel's syndrome with a large diverticulum and massive contents. Endoscopic removal provides immediate relief of the obstruction, and may be sufficient treatment for Lemmel's syndrome caused by a large juxtapapillary diverticulum with massive contents.