A rare pancreaticobiliary complication of duodenal diverticula is Lemmel syndrome. Lemmel syndrome is defined as an obstructive jaundice. ABSTRACT. In Lemmel was the first to report the presence of juxtapapillary diverticula and hepatocholangiopancreatic disease, excluding cholelithiasis. Lemmel’s syndrome, juxtapapillary diverticula, periampullary duodenal In Lemmel was the first to report the presence of juxtapapillary.

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Another important consideration is that not all forms of Lemmel syndrome can be attributed to extrinsic compression of the common bile duct CBD by periampullary diverticula.

Preferred treatment includes ERCP with sphincterotomy and biliary stent placement—associated with a reduced risk of morbidity and mortality [ 10 ]. Endoscopic therapeutics for patients with cholangitis caused by the juxtapapillary duodenal diverticulum.

Her past medical history was not relevant. Non-functioning Primary Neuroendocrine Tumor of the Liver While not clinically icteric, her laboratory investigations revealed an obstructive jaundice.

MRCP demonstrated mild distension of the gallbladder with several calculi. Lemmel’s syndrome as a rare cause of obstructive jaundice. There were no findings of bile duct stones or dilatation of the common bile duct. Acute obstructive cholangitis caused by an enterolith in a duodenal diverticulum.

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Endoscopy, 36pp. Once the papilla was located with a Fogarty catheter through the cystic duct, the diverticulum was dissected at its neck; the common bile duct was dissected above the area being compressed by the diverticulum, confirming the discharge of clean bile; the bile duct was ligated distally and reconstructed using Roux-en-Y choledochojejunostomy.


Syndrpme, 24 months after surgery, the patient is asymptomatic and has not presented any new episodes of abdominal pain or obstructive jaundice.

Shocket E, Simon SA. Table 1 outlines the admission and discharge liver function tests. Arch Verkrcht, 56pp. On axial CT scan, a high attenuated stone density with internal air black arrow is seen on distal common bile duct CBD A.

Biliary cannulation combined with endoscopic sphincterotomy EST was also performed to explore the CBD for other possible causes of obstructive jaundice but no stone, stricture or obstruction by tumor could be found. Sometimes these diverticula can be filled with fluid and misdiagnosed as a pancreatic abscess, cystic neoplasm in the pancreatic head, or as a metastatic lymph node [ 8 ].

Alexander Muacevic and John R Adler. Beta-glucuronidase activity in the bile of gallstone patients both with and without duodenal diverticula.

Lemmel Syndrome Secondary to Duodenal Diverticulitis: A Case Report

Contrast-enhanced Coronal and Sagittal CT of the Abdomen lwmmel Pelvis Pre-Treatment Contrast-enhanced reformatted images of the abdomen and pelvis demonstrate A an inflamed periampullary diverticulum, which obstructs the common bile duct arrow. B A more posterior slice demonstrates a dilated common bile duct and proximal intrahepatic ducts open arrow.

Acta Gastroenterol Belg ; Clin Res Hepatol Gastroenterol. There was intra- and extra-hepatic biliary dilatation to the level of the ampulla. To improve our services and products, we use “cookies” own or third parties authorized to show advertising related to client preferences through the analyses of navigation customer behavior.

Osteoclast-like giant cell tumor of the pancreas—an unusual presentation in a patient with large mantle cell lymphoma.

Lemmel syndrome was first described in by Lemmel as obstructive jaundice in the absence of gallstones due to a periampullary duodenal diverticulum.


During llemmel removal, CBD was also explored to search for other possible source of obstructive jaundice such as CBD stone since primary biliary stone is known to occur more frequently in the presence of PAD 9 In relatively asymptomatic patients, non-surgical or conservative treatment is recommended.

MRCP and ERCP in Lemmel Syndrome

After conducting lemmeel cholecystectomy, the common bile duct was released up to its end, along with the duodenal diverticulum, from the surrounding pancreatic tissue. Continuing navigation will be considered as acceptance of this use. She completed a day course of intravenous antibiotics, including metronidazole and levofloxacin. J Hepatobiliary Pancreat Surg. Find articles by Seung Young Kim. Lemmel syndrome is a rare condition that must be considered as a differential in cases of obstructive jaundice with no choledocholithiasis or tumour.

Maintaining a high index of suspicion is imperative to establish an accurate lemel since it can mimic other cystic or solid lesions around the pancreas head. To date, there are few published cases, and the etiopathogenesis has not been completely established. She had been well lemmel 6 months after enterolith removal, when the patient visited the outpatient clinic with vague abdominal discomfort.

Diagnosing Lemmel’s syndrome could be challenging, but being aware of this condition is important to avoid mismanagement and it begins with identification of PAD. Open in a separate window.

Histoire Acad R Sci Paris.