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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B An axial slice slightly more cephalad shows dilated intrahepatic bile ducts open arrow. Duodenal diverticula are classified based on their location. On duodenoscopy, the major duodenal papilla with a normal orifice was located in the periampullary duodenal diverticulum Image 2. J Hepatobiliary Pancreat Surg.

She denied any vomiting, abdominal pain, melena, haematochezia, haematemesis, fever, chills or altered bowel habit. When a biliary obstruction is present, excision of the diverticulum can be done, but the procedure is difficult and associated with significant mortality [ 6 ].

The clinical significance of the duodenal diverticulum Die klinische Bedeutung der Duodenaldivertikel. Are you a health professional able to prescribe syndeome dispense syndrom

Cureus is not responsible for the scientific accuracy or reliability of data or conclusions published herein. Computed tomography of the abdomen showed several gallbladder stones and gallbladder wall thickening. When these diverticula are located within cm of the ampulla of Vater they are termed periampullary diverticula [ 1 ].

No surgical option is free of the risk for complications; therefore, the treatment should be individualized according to the characteristics of the patient, the location of the diverticulum and the experience of the medical team.

Lemmel Syndrome Secondary to Duodenal Diverticulitis: A Case Report

Lemmel syndrome is a rare condition that must be considered as a differential in cases of obstructive jaundice with no choledocholithiasis or syndtome. In asymptomatic cases, treatment is not justified since the risk of developing complications is very low.


Association of periampullary duodenal diverticula with bile duct stones and with technical success of endoscopic retrograde cholangiopancreatography.

This re-demonstrated a periampullary duodenal diverticulum with adjacent inflammatory changes. Syndromr, on coronal reconstructed images, the stone was not located within the bile duct but inside the PAD and the distended diverticulum was compressing the mid CBD Fig. Conclusions Lemmel syndrome is a rare cause of biliary obstruction. Receive exclusive offers and updates from Oxford Academic.

Non-functioning Primary Neuroendocrine Tumor of the Liver The Impact Factor measures the average number of citations received in a particular year by papers published in the journal during the two receding years. Published online Mar 1. Using CT scan and MRCP, periampullary diverticula may appear as thin-walled cavitary lesions on the medial wall of the second portion lejmel the duodenum.

Subscribe to our Newsletter. These include duodenal syjdrome causing dysfunction of the sphincter of Oddi as well as compression of the common bile duct by duodenal diverticula.

Lemmel syndrome | Radiology Reference Article |

Various management options exist ranging from endoscopic extraction of entrapped material, extracorporeal shock wave lithotripsy, to laparoscopic diverticulectomy [ 10 ]. Excision of a juxtapapillary duodenal diverticulum causing biliary obstruction: The remaining laboratory values were unremarkable. SRJ is a prestige metric based on the idea that not all citations are the same.

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 lemmrl common bile duct arrow. Endoscopic nasobiliary drainage tubogram obtained after decompression of the PAD demonstrates resolved extrinsic compression B. Surg Laparosc Endosc Percutan Tech, 16pp.


An ultrasound of abdomen displayed distension of the gallbladder with a large lfmmel of stones and sludge, as well as intra- and extra-hepatic biliary ductal dilatation. J Hepatobiliary Pancreat Surg. Dig Surg, 27pp. Lemmel’s syndrome as a rare cause of synerome jaundice. MRCP is a noninvasive imaging modality which is useful for examination of patients with synerome jaundice.

Case 1 Case 1. Manabe T, Yu GS. There was a grid-iron incision in the right iliac fossa.

Introduction Duodenal diverticula are most often found in the second part of the duodenum adjacent to the ampulla of Vater. However, PAD are sometimes filled with fluid and can frequently be mistaken for pancreatic pseudocyst, pancreatic abscess, cystic neoplasm in the pancreas head or even metastatic lymph node 12 A rare pancreaticobiliary complication of duodenal diverticula is Lemmel syndrome. More on this topic Massive hiatus hernia complicated by jaundice.

For commercial re-use, please contact journals. There was intra- and extra-hepatic biliary dilatation to the level of the ampulla.

The existence of a juxtapapillary diverticulum is associated with the elevated incidence of biliopancreatic disease due to, on the one hand, the extrinsic compression symdrome the diverticulum itself on the bile duct Lemmel’s lekmel and, on the other hand, it may favor bacterial overgrowth and consequently the production of biliary lithiasis due to beta-glucuronidase activity, in addition to inducing sphincter of Oddi dysfunction, leading to stasis and biliary reflux from the duodenum to the common bile duct.