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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Pathologic mechanisms through which Lemmel’s syndrome is thought to occur include the following. Preferred treatment includes ERCP with sphincterotomy and biliary stent placement—associated with a reduced risk of morbidity and mortality [ 10 ].
Surg Laparosc Endosc Percutan Tech, 16pp. Otherwise, the other abdominal organs were normal.
Various management options exist ranging from endoscopic extraction of entrapped material, extracorporeal shock wave lithotripsy, to laparoscopic diverticulectomy [ 10 ]. In addition, alkaline phosphatase, serum aspartate aminotransferase ASTalanine transaminase ALTand white cell count were all elevated.
Lemmel syndrome is defined as an obstructive jaundice caused by a periampullary duodenal diverticulum compressing the intra-pancreatic portion of the common bile duct with resultant dilatation of the extra- and intra-hepatic bile ducts. Previous article Next article.
Report of a case of duodenal diverticulum containing gallstones. Email alerts New issue alert. You can also scroll through stacks with your mouse wheel or the keyboard arrow keys. After removal of the enterolith within the PAD, all her symptoms resolved.
She completed a day course of intravenous antibiotics, including metronidazole and levofloxacin. CT scan and MRCP will demonstrate periampullary lemmwl on the medial wall synvrome the second portion of the duodenum. Therefore, high index of suspicion is mandatory to arrive at a correct diagnosis in these patients.
J Korean Med Sci.
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CT lememl MR imaging findings in seven patients. About Blog Go ad-free. An year-old lady presented to the emergency department with a 6-week history of general deterioration. 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.
Non-functioning Primary Neuroendocrine Tumor of the Liver The remaining laboratory values were unremarkable.
Lemmel Syndrome Secondary to Duodenal Diverticulitis: A Case Report
Another important consideration is that not all forms of Lemmel syndrome can be attributed to synndrome compression of the common bile duct CBD by periampullary diverticula. Support Center Support Center. 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.
Since ERCP did not guarantee definitive treatment, the patient was referred to our surgical service. When these diverticula are located within cm of the ampulla of Vater they are termed periampullary diverticula [ 1 ].
Visit for more related articles at JOP. Since ERCP did not guarantee definitive treatment, the patient was referred to our surgical service. However, many patients with Syndroje syndrome do present with some form of symptoms related to biliary obstruction secondary to extrinsic compression of the common bile duct and treatment may be warranted.
Lemmel syndrome | Radiology Reference Article |
Contrast-enhanced Axial A and Coronal B CT Images of the Abdomen and Pelvis Post-Treatment Contrast-enhanced axial A and coronal B CT images of the abdomen and pelvis two weeks after conservative treatment demonstrate a small duodenal diverticulum with significantly improved surrounding inflammatory changes arrows. Lemmel syndrome occurs when a duodenal diverticulum causes obstructive jaundice due to a mechanical obstruction of the common bile duct.
Her entire physical examination was negative, including the absence of jaundice. Duodenal diverticula most commonly occur within 3 cm of the ampulla of Vater, and these diverticula are termed periampullary diverticula PAD [ 8 ]. Most of these periampullary diverticuli remain asymptomatic and are diagnosed incidentally, but rarely can cause pancreaticobiliary or non-pancreaticobiliary complications.
Received Aug 17; Accepted Mar 1. Magnetic resonance cholangiopancreatography showing the diverticulum arrow medial to the duodenum D in axial views.
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We present the case of a year-old male with a history of hypertension and dyslipidemia. J Hepatobiliary Pancreat Surg. Although CBD was explored in our case, no other etiology of obstructive jaundice could be identified other than extrinsic compression by distended PAD. She was a nursing home resident who was largely dependent in activities of daily living. Second, periampullary diverticula may cause dysfunction of synerome sphincter of Oddi. Pancreaticobiliary complications can present as recurrent gallbladder or bile duct stones, obstructive jaundice, cholangitis, or acute pancreatitis [ 5 ].
B The sagittal image provides another view of the duodenal diverticulitis and common bile duct dilation arrows. 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 arrow. Diverticula are sac-like protrusions of all or part of the bowel wall that can occur anywhere along the gastrointestinal tract [ 1 ]. A year-old previously healthy woman presented to the emergency department without any significant past medical history.
Human Ethics Consent was obtained by all participants in this study. Contrast-enhanced axial A and coronal B CT images of the abdomen and pelvis two weeks after conservative treatment demonstrate a small duodenal diverticulum with significantly improved surrounding inflammatory changes arrows. Periampullary duodenal diverticula PAD are those that develop within a 2—3 cm radius from the ampulla of Vater [ 3 ].
J Am Coll Surg,pp. This re-demonstrated a periampullary duodenal diverticulum with adjacent inflammatory changes. CT characterisation of pancreatic neoplasm: