{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,28]],"date-time":"2026-02-28T10:56:47Z","timestamp":1772276207210,"version":"3.50.1"},"reference-count":8,"publisher":"BMJ","issue":"3","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2019,2,25]]},"published-print":{"date-parts":[[2019,3]]},"abstract":"<jats:p>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\u2009days 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\u2019s syndrome. Due to potential surgical risk, we decided for a conservative approach. The patient had a favourable course and was discharged home.<\/jats:p>","DOI":"10.1136\/bcr-2018-228401","type":"journal-article","created":{"date-parts":[[2019,3,16]],"date-time":"2019-03-16T14:44:14Z","timestamp":1552747454000},"page":"e228401","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["A rare cause of abdominal pain with fever"],"prefix":"10.1136","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1466-3855","authenticated-orcid":false,"given":"Diana Martins","family":"Oliveira","sequence":"first","affiliation":[{"name":"Internal Medicine, Hospital and University Center of Coimbra, Coimbra, Portugal"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Catarina","family":"Correia","sequence":"additional","affiliation":[{"name":"Gastroenterology Department, Centro Hospitalar e Universit\u00e1rio de Coimbra, Coimbra, 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