A Rare Indication for Percutaneous Transhepatic Cholangiography: Treatment of Obstructive Jaundice due to Compression of a Bezoar Filled-Duodenal Diverticulum (Lemmel Syndrome)

Introduction: Lemmel syndrome occurs when the primarily intrapancreatic portion of the common bile duct is compressed or obstructed by a duodenal diverticulum. This can cause jaundice due to the pressure. Case Presentation: A 65-year-old female patient was admitted to the emergency room with Lemmel syndrome. The patient underwent endoscopic retrograde cholangiopancreatography (ERCP), confirming the diagnosis of a diverticulum. The papilla was located in the diverticulum, and despite various attempts and maneuvers, it could not be cannulated. Subsequently, percutaneous transhepatic cholangiography (PTC) was performed, and an 8F drainage catheter was successfully placed in the duodenum. Conclusion: Lemmel syndrome is a rare condition that may cause acute abdomen with obstructive jaundice. Increased awareness and familiarity with imaging can help distinguish the diverticulum from tumors, potentially saving the patient from unnecessary surgeries. If ERCP fails, PTC may be a successful alternative for the treatment of jaundice.