dawnmedDawnMed Journal of Medical ScienceISVolume 2, Issue 4MultidisciplinaryEnglish2026NNY2026109Gastroenterology / HepatologyLemmel Syndrome Masquerading as an Ampullary Mass: A Case Report and Mini-ReviewEnglishY3137Jomana NasserAlkhraisi¹EnglishNWaad Mohammed AbuNakha²EnglishYDeyala RiyadhAlzaheb¹EnglishYSarahAlomran³EnglishYGhala TawfiqAldarwish³EnglishYJoud Abdulhafith A.AlAhmady⁴EnglishYWaleedBadoghaish¹*EnglishYBackground: Lemmel syndrome is an uncommon cause of obstructive jaundice due to a periampullary duodenal diverticulum. Its diagnosis can be challenging when the diverticulum mimics an ampullary mass.Case Presentation:A 77-year-old man presented with jaundice, anorexia, fever, chills, and right upper quadrant pain. Laboratory investigations showed a mixed cholestatic and hepatocellular pattern of liver injury with elevated inflammatory markers. Computed tomography (CT) demonstrated an enhancing polypoid lesion involving the ampulla, distal common bile duct dilatation with a filling defect read as a stone, mild pancreatic duct dilatation, and multiple large gallbladder stones, raising concern for an ampullary tumor and choledocholithiasis. Initial endoscopic retrograde cholangiopancreatography (ERCP) failed because the suspected mass obstructed access to the papilla. With recurrent fever, tachycardia, blood cultures positive for Gram-negative coccobacilli, and worsening inflammatory and cholestatic markers, percutaneous transhepatic biliary drainage was performed after limited improvement with cholecystostomy. A subsequent cholangiogram and cholangioscopy demonstrated a distal common bile duct outpouching without a stone. A dedicated repeat magnetic resonance cholangiopancreatography (MRCP) identified a non-enhancing, non-restricting periampullary cystic structure consistent with an inverted duodenal diverticulum, supporting the diagnosis of Lemmel syndrome. A subsequent rendezvous ERCP was successfully performed with common bile duct stent placement, and he was discharged in good condition.Conclusion:This case shows the diagnostic challenge of Lemmel syndrome when a periampullary diverticulum mimics malignancy on initial imaging, and the role of repeat dedicated imaging, cholangioscopy, percutaneous biliary drainage, and rendezvous ERCP when conventional ERCP is unsuccessful.EnglishLemmel Syndrome; Periampullary Duodenal Diverticulum; Obstructive Jaundice; Cholangitis; Ampullary Mass; ERCP; MRCP.https://dawnmed.com.sa/abstract?id=38References1619Love JS, Yellen M, Melitas C, Yazici C, Zar F. Diagnosis and management of Lemmel syndrome: an unusual presentation and literature review. 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