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A rare cause of abdominal pain with fever
  1. Diana Martins Oliveira1,
  2. Catarina Correia2,
  3. Flávia Cunha3 and
  4. Patrícia Dias1,4
  1. 1 Internal Medicine, Hospital and University Center of Coimbra, Coimbra, Portugal
  2. 2 Gastroenterology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
  3. 3 Infectious Diseases, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
  4. 4 Internal Medicine, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
  1. Correspondence to Dr Diana Martins Oliveira, difilipa_oliveira{at}


An 89-year-old man presented to the emergency department with a 1-month history of upper right quadrant pain, worsened in the last 3 days and accompanied by fever and chills. On physical examination, he had scleral icterus and right upper quadrant tenderness. Laboratory findings showed hyperbilirubinemia, elevated liver enzymes and C reactive protein. The patient was admitted, suspecting of an acute cholangitis and started on antibiotics. An upper gastrointestinal endoscopy revealed the presence of a juxtapapillary diverticulum in the second portion of the duodenum, which was confirmed by a magnetic resonance cholangiopancreatography, along with upstream biliary tract ectasia. The imaging findings allowed us to diagnose a Lemmel’s syndrome. Due to potential surgical risk, we decided for a conservative approach. The patient had a favourable course and was discharged home.

  • pancreas and biliary tract
  • infection (gastroenterology)

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  • Contributors DMO wrote the manuscript with support from CC, FC and PD. PD helped supervise the work and conceived the original idea.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.