CLINICAL IMAGING MRCP and ERCP in Lemmel Syndrome

A 63-year-old male was referred for jaundice and general fatigue. Computed tomography of the abdomen showed several gallbladder stones and gallbladder wall thickening. The laboratory data was the following: total bilirubin 2.2 mg/dL (reference range: 0.2-1.1 mg/dL), direct-bilirubin 0.6 mg/dL (reference range: 0-0.2 mg/dL), SGOT 46 IU/L (reference range: 12-32 IU/L), SGPT 79 IU/L (reference range: 7-43 IU/L), GGT 254 IU/L (reference range: 9-70 IU/L). After admission, coronal heavily T2-weighted single-shot rapid acquisition with relaxation enhancement magnetic resonance cholangiopancreatography (MRCP), carried out without secretin injection, demonstrated a lateral compression of the distal common bile duct (Image 1).On duodenoscopy, the major duodenal papilla with a normal orifice was located in the periampullary duodenal diverticulum (Image 2). Endoscopic retrograde cholangiopancreatography (ERCP) with injection of contrast material into the diverticulum