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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J Hepatobiliary Pancreat Surg. Juxtapapillary duodenal diverticula and pancreatobiliary disease. Published online Mar 1. B An axial slice slightly more cephalad shows dilated intrahepatic bile ducts open arrow. A year-old male was referred for jaundice and general fatigue. To date, there are few published cases, and the etiopathogenesis has not been completely established. Alexander Muacevic and John R Adler. There was a grid-iron incision in the right iliac fossa.

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Although PAD usually do not cause symptoms, it can serve as a source of obstructive jaundice even when choledocholithiasis or tumor is not present. Among these complications, hepatocholangiopancreatic disease can seldomly occur in the absence of choledocholithiasis and is termed ,emmel syndrome 2.

Endoscopic retrograde cholangiopancreatographic findings of enterolith within the periampullary diverticulum PAD and its removal.

MRCP and ERCP in Lemmel Syndrome

Regarding treatment, surgical excision of the diverticulum is appropriate in certain clinical scenarios. Maintaining syndroem high index of suspicion is imperative to establish an accurate diagnosis since it can mimic other cystic or solid lesions around the pancreas head.


Open in a separate window. Her entire physical examination was negative, including the absence of jaundice.

Additional pathophysiologic processes may also contribute to the development of Lemmel syndrome. A year-old previously healthy syndroe presented to the emergency department without any significant past medical history.

Duodenal diverticula are most often found in the second part of the duodenum adjacent to the ampulla of Vater. Dig Surg, 27pp.

MRCP demonstrated mild distension of the gallbladder with several calculi. Ultrasound showed a dilation of the proximal third of the common bile duct up to 1 cm, although the distal two-thirds could not be visualized. Imaging is critical in diagnosing Lemmel syndrome.

Lemmel syndrome | Radiology Reference Article |

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 syndrkme perform EST Acute obstructive cholangitis caused by an enterolith in a duodenal diverticulum. Lemmel syndrome was first described in by Lemmel as obstructive jaundice in the absence of gallstones due to a periampullary lemme diverticulum.

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.


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. However, 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.

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syndromr Extrinsic compression of the common bile duct may require surgery. 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.

The clinical significance of the 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. A case of Lemmel’s syndrome caused by a large diverticular enterolith at the peripapillary portion of the duodenum. All Published work is licensed under a Creative Commons Attribution 4.