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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Subscribe to our Newsletter. Sao Paulo Med J. This can be recurrent or complicated by cholangitis, which is attributed to mechanical compression of the terminal bile duct by diverticulum [ 6 ]. Author information Article notes Copyright and License information Disclaimer. When these diverticula are located within cm of the ampulla of Vater they are termed periampullary diverticula [ 1 ]. In the postoperative period, the patient had a subphrenic abscess that was drained surgically and a biliary fistula that was resolved with conservative management.

Recognition of this condition is important, as delayed diagnosis leemmel result in unnecessary further investigations. PAD are mainly asymptomatic but can, in rare circumstances, cause pancreaticobiliary complications when simultaneously inflamed [ 4 ].

The existence of a juxtapapillary diverticulum is associated with the elevated incidence of biliopancreatic disease synxrome to, on the one hand, the extrinsic compression of the diverticulum itself on the bile duct Lemmel’s syndrome 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 lemkel reflux from the duodenum to the common bile duct.

About Blog Go ad-free. His symptoms and laboratory data improved quickly after admission. MR cholangiopancreatography of Mirizzi syndrome and Lemmel syndrome. Find articles by Jong Jin Hyun.


Lemmel Syndrome Secondary to Duodenal Diverticulitis: A Case Report

Histoire Acad R Sci Paris. Citing articles via Google Scholar. Additionally, articles published within Cureus should not be deemed a suitable substitute for the advice of a qualified health care professional. First, diverticulitis or direct mechanical irritation of PAD may cause chronic inflammation of ampulla and lead to chronic fibrosis of papilla papillitis chronica fibrosa 4. Diagnosis and management of the symptomatic duodenal diverticulum: We present the case of a year-old male with a history of hypertension and dyslipidemia.

Find articles by Sung Woo Jung. Endoscopic nasobiliary drainage tubogram obtained after decompression of the PAD demonstrates resolved extrinsic compression B. Nihon Ronen Igakkai Zasshi.

Introduction Duodenal diverticula are most often found in the second part of the duodenum adjacent to the ampulla of Vater.

MRCP and ERCP in Lemmel Syndrome | Insight Medical Publishing

A year-old previously healthy woman presented to the emergency department without any significant past medical history. Among these complications, hepatocholangiopancreatic disease can seldomly occur in the absence of choledocholithiasis and is termed Lemmel’s syndrome 2.

This syndrrome revealed a large periampullary diverticulum with mucosal enhancement and fat stranding consistent with diverticulitis. The remaining laboratory values were unremarkable.

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During surgery, a 4 cm diverticulum syndrrome found on the posteromedial side of the second duodenal portion of the juxtapapillary duodenum, which was compressing the distal bile duct and contained food debris. Enterolith formation within the duodenal diverticula is known to be facilitated in the static environment such as a blind loop after gastrectomy or proximal portion of stricture formed by Crohn’s disease syhdrome tuberculosis 8.

Obstructive Jaundice Secondary to a Duodenal Diverticulum. Discussion 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.


Regarding treatment, surgical excision of the synfrome is appropriate in certain clinical scenarios. Human Ethics Consent was obtained by all participants in this study.

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Please cite this article as: Third, the distal common bile duct or ampulla can be compressed mechanically by periampullary lemme as occurs in our case [ 7 ]. Lemmel’s syndrome is an uncommon pathology first described in1 defined as lmemel jaundice due to a periampullary duodenal diverticulum in the absence of choledocholithiasis or neoplasm.

It is an obstructive jaundice in the absence of gallstones primarily due to a periampullary duodenal diverticulum.

Periampullary diverticula and pancreaticobiliary disease. J Hepatobiliary Pancreat Surg. She completed a day course of intravenous antibiotics, including metronidazole and levofloxacin. Excision of a juxtapapillary duodenal diverticulum causing biliary obstruction: This finding is depicted in line art to better delineate the anatomical relationship C.

Manabe T, Yu GS. J Hepatobiliary Pancreat Surg.

A rare pancreaticobiliary complication of duodenal diverticula is Lemmel syndrome. Diverticulitis of the duodenum: Excision of a juxtapapillary duodenal diverticulum causing biliary obstruction: On axial CT scan, a high attenuated stone density with internal air black arrow is seen on distal common bile duct CBD A.

In addition, alkaline phosphatase, serum aspartate aminotransferase ASTalanine transaminase ALTand white cell count were all elevated. Surg Laparosc Endosc Percutan Tech, 16pp.

B An axial slice slightly more cephalad shows dilated intrahepatic bile ducts open arrow.