Navigating a Challenging Lemmel’s Syndrome Case: An Atypical Presentation of a Rare Complication

Duodenal diverticula are uncommon anatomical anomalies that can lead to significant clinical challenges, particularly when associated with complications such as lemmel’s syndrome. We report the case of a 72-year-old male admitted to our department with epigastric pain, vomiting, Keto-acidosis, and elevated C-reactive protein (CRP) levels. Initial gastroscopy revealed a gastric stasis, and a large duodenal diverticulum. Subsequent computed tomography (CT) imaging showed a dilated common bile duct (CBD) and main pancreatic duct (MPD), along with signs of pancreatitis and a liver abscess, likely secondary to cholangitis. The patient was managed conservatively with intravenous antibiotics and supportive care, including fluid resuscitation and analgesia. Despite the initial severity of the condition, the patient’s symptoms improved significantly with medical management alone, obviating the need for surgical intervention. Follow-up imaging demonstrated resolution of the liver abscess and reduction in ductal dilatation. The patient was discharged in stable condition and remained asymptomatic during subsequent follow-ups. This case underscores the potential complications of duodenal diverticula and the importance of considering these diagnoses in patients presenting with duodenal diverticula and non-specific abdominal symptoms and elevated inflammatory markers. The successful conservative management highlights the viability of non-surgical and non-endoscopic treatments in selected cases, reducing the risks associated with such procedures. Comprehensive diagnostic imaging, a multidisciplinary treatment approach and a close follow-up are crucial for avoiding the need for surgery and achieving favorable outcomes. This case contributes to support conservative management in certain clinical scenarios.