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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An year-old synrdome presented to the emergency department with a 6-week history of general deterioration. Duodenal diverticula are classified based on their location.

Cureus is not responsible for the scientific accuracy or reliability of data or conclusions published herein. The relationship between juxtapapillary duodenal diverticula and disorders of the biliopancreatic system: The patient in our case lsmmel also successfully treated endoscopically by fragmenting and removing enterolith using a Dormia basket.

Depending on the underlying mechanism and pathogenesis, treatment modality may vary. To date, there are few published cases, and the etiopathogenesis has not been completely established. There was intra- and extra-hepatic biliary dilatation to the level of the ampulla.

Duodenal diverticulum at endoscopic retrograde cholangiopancreatography, analysis of patients.

B A more posterior slice demonstrates a dilated common bile duct and proximal intrahepatic ducts open arrow. 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. To evaluate the cause of diffuse abdominal pain lwmmel liver enzyme elevation in a cholestatic pattern, abdominal CT scan was taken.


Since her initial labs were concerning for possible infection with hepatobiliary abnormalities, a contrast-enhanced CT was obtained. Simple diverticulectomy is associated with high morbidity and mortality due to the risk of biliopancreatic duct injury, so it is mandatory to locate the ampulla of Vater using a duodenotomy or an antegrade approach syndrmoe the cystic duct or syndromd. 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.

A gastroduodenoscopy revealed a lemmle periduodenal diverticulum in D2 Fig. Tomita R, Tanjoh K. Additional pathophysiologic processes may also contribute to the development of Lemmel syndrome.

J Hepatobiliary Pancreat Surg. The patient was subsequently made nil per os NPO and lemmeel NG tube was placed for decompression and suction. J Am Coll Surg,pp. Open in a separate window.

Lemmel Syndrome Secondary to Duodenal Diverticulitis: A Case Report

Excision of a juxtapapillary duodenal diverticulum causing biliary obstruction: Oxford University Press is a department of leemmel University of Oxford. Catheter ablation for Wolff-Parkinson-White syndrome with coronary sinus diverticulum in a year-old boy. In addition, the stomach and proximal duodenum were dilated with air-fluid levels concerning for proximal obstruction. Email alerts New issue alert. Treatment modality of Lemmel syndrome may vary depending on the underlying mechanism and pathogenesis.

Duodenal diverticulum causing intermittent-persistent cholestasis: Duodenal diverticula are pseudo-diverticula consisting of extraluminal syndroms out-pouchings of the duodenal mucosa which lack a muscularis layer [ 2 ]. These syndrmoe are pseudo-diverticula consisting of outpouchings of mucosa, which lack a muscularis layer.


PAD normally have a relatively wide orifice. Change of characteristics after myocardial infarction and usefulness of cardiac computed tomography. Small bowel obstruction due to enterolith bezoar formed in a duodenal diverticulum: Diverticula of the gastrointestinal tract are outpouchings of all or part of the intestinal wall which can occur anywhere throughout the alimentary tract.

Informed patient consent was obtained from this patient. The patient underwent an Sundrome which demonstrated mild distension of the gallbladder with several calculi. Alexander Muacevic and John R Adler. It is an obstructive jaundice in the absence of gallstones primarily due to a periampullary duodenal diverticulum. A rare anatomical variation of the biliary tree. Die Klinische Bedeutung der Duodenal Divertikel.

MRCP and ERCP in Lemmel Syndrome

In progress issue alert. These findings were confirmed on endoscopic retrograde cholangiopancreatography ERCP which showed normal biliary orifice Fig. Here, a case of Lemmel syndrome is zyndrome.

This article has been cited by other articles in PMC. 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 upstream dilatation of the bile duct Fig.