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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The most plausible explanation is that EST performed during CBD exploration at the time of enterolith removal has permitted the occurrence of ascending infection with resultant brown pigment stone formation.

Second, PAD many cause dysfunction in the sphincter of Oddi 5. The authors have declared that no competing interests exist. Endoscopic therapeutics for patients with lemme caused by the juxtapapillary duodenal diverticulum. Lemmmel articles by Sang Woo Lee. PAD normally have a relatively wide orifice. We report the case of a year-old female presenting with unintentional weight loss and fatigue. B A more posterior slice demonstrates a dilated common bile duct and proximal intrahepatic ducts open arrow.

Conclusions Lemmel syndrome is a rare cause of biliary obstruction. When the CBD stone was removed by ERCP, the stone proved to be brown pigment sludge stone that typically forms in the presence of ascending infection Fig.

MRCP and ERCP in Lemmel Syndrome | Insight Medical Publishing

Lateral compression of the distal common bile duct on MRCP without secretin injection implies the possibility of periampullary duodenal diverticulum. Using CT scan and MRCP, periampullary diverticula may appear as thin-walled cavitary lesions on the medial wall of the second portion of the duodenum.

She had a pound unintentional weight loss, fatigue, and weakness that began three months prior. A case of duodenal diverticulum mimicking a peripancreatic abscess. Diagnosis and management of the symptomatic 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.


The relationship between juxtapapillary duodenal diverticula and disorders of the biliopancreatic system: While not clinically icteric, her laboratory investigations revealed an obstructive jaundice.

After removal of the enterolith within the PAD, all her symptoms resolved. This duodenal diverticulum obstructive jaundice syndrome is called Lemmel’s syndrome. First, direct mechanical irritation of periampullary diverticula may cause chronic inflammation of the ampulla, which leads to fibrosis of the papilla. Tomita R, Tanjoh K. Abstract An year-old female, with a known periampullary lemme duodenal diverticulum, presented to the emergency department with general deterioration.

Duodenal diverticula mimicking cystic neoplasms of the pancreas: She denied any vomiting, abdominal pain, melena, haematochezia, haematemesis, fever, chills or altered bowel habit. A case of Lemmel’s syndrome caused by a large diverticular enterolith at the peripapillary portion of the duodenum. Duodenal diverticulum causing intermittent-persistent cholestasis: After syndromr, coronal heavily T2-weighted single-shot rapid acquisition with relaxation enhancement magnetic resonance cholangiopancreatography MRCPcarried out without secretin injection, demonstrated a lateral lememl of the distal common bile duct Image 1.

The patient in our case was lemmeel successfully synfrome endoscopically by fragmenting synrrome removing enterolith using a Dormia basket.

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Gastrointestinal diverticula are outpouchings of the intestinal wall, which can occur anywhere throughout the gastrointestinal tract and are most often found in the colon, followed by the duodenum. Am J Surg, 26pp. Various management options exist ranging from endoscopic extraction of entrapped material, extracorporeal shock wave lithotripsy, to laparoscopic diverticulectomy [ 10 ]. In the postoperative period, the patient had a subphrenic abscess that was drained surgically and a biliary fistula that was resolved with conservative management.


Rarely, obstructive jaundice can develop secondary to PAD without choledocholithiasis or tumour in the setting of Lemmel syndrome [ 5 ]. Lemmel’s syndrome as a rare cause of obstructive jaundice.

Lemmel Syndrome Secondary to Duodenal Diverticulitis: A Case Report

Since ERCP did not guarantee definitive treatment, the patient was referred to our surgical service. Synonyms or Alternate Spellings: Diverticula are sac-like protrusions of all or part of the bowel wall that can occur anywhere along the gastrointestinal tract [ 1 ].

Therapeutic options in this situation run the gamut from endoscopic extraction of entrapped material, extracorporeal shock wave lithotripsy to surgery diverticulectomy or biliodigestive anastomosis 714 Synsrome these diverticula are located within cm of the ampulla of Vater they are termed periampullary diverticula [ 1 ]. They are more frequently located in the second portion of the duodenum, close to the ampulla of Vater juxtapapillary due to the weakness of the wall in this area.

Human Ethics Consent was kemmel by all participants in this study.

Periampullary duodenal diverticula PAD are those that develop within a 2—3 cm radius from the ampulla of Vater [ 3 ]. Association of periampullary diverticula with primary choledocholithiasis. Among these complications, hepatocholangiopancreatic disease can seldomly occur in the absence of choledocholithiasis and is termed Syndrime syndrome 2.

Although the majority of periampullary diverticula are asymptomatic, occasionally non-pancreaticobiliary or pancreaticobiliary complications can occur.