Duodenal diverticulum is a disease that clinicians commonly encounter in ordinary clinical work. Most cases are rarely regarded as clinical problems because of their asymptomatic progress. Among these cases, since Lemmel reported the clinical significance of juxtapapillary duodenal diverticula in 1934, describing them as Papillensyndrom, the effect of juxtapapillary duodenal diverticula on biliary-pancreatic diseases has been discussed due to the anatomical relationship of diverticula and the papilla of Vater. Although Lemmel syndrome's frequency, impact on each disease and operative procedure have been reported in Japan, its clinical significance is still unclear. Until now, no guidelines regarding the therapeutic indication of juxtapapillary duodenal diverticula have been established, so a suitable therapeutic strategy needs to be selected for each patient.Here, we report a case of 60-year-old Japanese woman who repeatedly developed acute cholangitis and pancreatitis in a short period due to Lemmel syndrome, which was comprehensively diagnosed based on various imaging findings.

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The presence of anti-ARS antibody is strongly associated with ILD, myositis, arthritis, Raynaud phenomenon, and mechanic's hand.• Multiple finger gangrene and DAD do not usually develop in patients with anti-ARS antibody. • Clinicians should consider concomitant malignancy in patients with anti-ARS antibody who present with unusual manifestations.