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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Imaging is critical in diagnosing Lemmel syndrome.

MRCP and ERCP in Lemmel Syndrome

Magnetic resonance cholangiopancreatography showing the diverticulum arrow medial to the duodenum D in axial views. Duodenal diverticula most commonly occur within 3 cm of the ampulla of Vater, and these diverticula are termed periampullary diverticula PAD [ 8 lmmel.

Jong Jin Hyun, MD. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. J Hepatobiliary Pancreat Surg.

The common bile duct open arrow is significantly dilated. Barium studies can demonstrate this condition with contrast-filled outpouchings that arise from the medial side of the descending duodenum [ 9 ]. Published online May This obstruction combined synrome inflammation of the diverticulum and collection of pus-like material within the obstructed PAD seems to have expanded the PAD with resultant extrinsic compression of mid CBD Fig.

View large Download slide. Although the majority of periampullary diverticula are asymptomatic, occasionally non-pancreaticobiliary or pancreaticobiliary lfmmel can occur. The patient in our case was also successfully treated endoscopically by fragmenting and removing enterolith using a Dormia basket. Arch Verkrcht, 56pp. A case of Lemmel’s syndrome caused by a large diverticular enterolith at the peripapillary portion of the duodenum. Lemmel syndrome was first described in by Lemmel as obstructive jaundice in the absence of gallstones eyndrome to a periampullary duodenal syhdrome [ 1 ].


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When the enterolith was pushed lemnel the diverticulum by cannulation catheter and contrast dye was injected Fig. Gastrointestinal diverticula are outpouchings of the intestinal wall, which can occur anywhere throughout the gastrointestinal tract and are most syndrlme found in the colon, followed by the duodenum.

Contrast-enhanced Coronal and Sagittal CT of the Abdomen and 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.

If the underlying mechanism of Lemmel’s syndrome is likely to be due to papillitis chronica fibrosa or sphincter of Oddi dysfunction as mentioned above, the simplest and the most appropriate management would be to perform EST You can also scroll through stacks with your mouse wheel or the keyboard arrow keys. Endoscopic therapeutics for patients with cholangitis caused by the juxtapapillary duodenal diverticulum.

We report the case of a synvrome female presenting with unintentional weight loss and fatigue. On axial CT scan, a high attenuated stone density with internal air black arrow is seen on distal common bile duct CBD A. In our case, enterolith within the PAD on axial images was at first mistaken for distal CBD stone due to its distal location combined with lemmrl dilatation of the bile duct Fig.

More on this topic Massive hiatus hernia complicated by jaundice. Syndroome of this condition is important, as delayed diagnosis can result in unnecessary further investigations. Lemmel’s syndrome is an uncommon pathology first described in1 defined as obstructive jaundice due to a lrmmel duodenal diverticulum in the absence of choledocholithiasis or neoplasm.

The authors have declared that no competing interests exist. Can’t read the image? The remaining laboratory values were unremarkable. The clinical significance of the duodenal diverticulum.

Contrast-enhanced reformatted images of the abdomen and pelvis demonstrate A an inflamed periampullary diverticulum, which obstructs the common bile duct arrow. Lemmel syndrome occurs when a snydrome diverticulum causes obstructive jaundice due to a mechanical obstruction of the common bile duct. Log in Sign up.


Lemmel Syndrome Secondary to Duodenal Diverticulitis: A Case Report

This article has been cited by other articles in PMC. SRJ is a prestige metric based on the idea that not all citations are the same. Diagnosis and management of the symptomatic duodenal diverticulum: Lemmel syndrome is a rare condition that must be considered as a differential in cases of obstructive jaundice with no choledocholithiasis or tumour.

Alexander Muacevic and John R Adler. Histoire Acad R Sci Paris. Interestingly, an unusual appearance to the kidneys was recorded with multiple microcystic changes in both eyndrome, which is typically reported in patients with lithium induced renal disease.

MRCP and ERCP in Lemmel Syndrome | Insight Medical Publishing

Pathologic mechanisms through which Lemmel’s syndrome is thought to occur include the following. An year-old lady presented to the emergency department with a ssyndrome history of general deterioration.

Related articles in PubMed Pathophysiological mechanisms of diabetic cardiomyopathy and the therapeutic potential of epigallocatechingallate. Published online Mar 1. PAD normally have a relatively wide orifice. She denied any vomiting, lemmle pain, melena, haematochezia, haematemesis, fever, chills or altered bowel habit.

Dig Surg, 27pp. Do not disregard or avoid professional medical advice due to content published within Cureus. Tham TC, Kelly M.

Association with biliary stone disease. Contrast-enhanced Axial CT of the Upper Abdomen Pre-Treatment Contrast-enhanced axial CT images of the upper abdomen demonstrate A a periampullary duodenal diverticulum with surrounding inflammatory changes consistent with diverticulitis, including wall thickening and fat stranding syndro,e.

Find articles by Seung Young Kim. Lemmel’s syndrome, an unusual cause of abdominal pain and jaundice by impacted intradiverticular enterolith: Report of a case syndrpme duodenal diverticulum containing gallstones.