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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Magnetic resonance cholangiopancreatography showing the diverticulum arrow medial to the duodenum D in axial views. Non-functioning Primary Neuroendocrine Tumor of the Liver Beta-glucuronidase activity in the bile of gallstone patients both with and without duodenal diverticula. Pancreaticobiliary complications can present as recurrent gallbladder or bile duct stones, obstructive jaundice, cholangitis, or acute pancreatitis [ 5 ].

Lemmel Syndrome Secondary to Duodenal Diverticulitis: A Case Report

Excision of a juxtapapillary duodenal diverticulum causing biliary obstruction: She had a pound unintentional weight loss, fatigue, and weakness that began three months prior. Treatment is generally not recommended in asymptomatic patients or would be conservative management in pauci-symptomatic patients.

J Hepatobiliary Pancreat Surg.

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. MR cholangiography in the evaluation of patients with duodenal periampullary diverticulum.

This obstruction combined with inflammation of the diverticulum and collection of pus-like material within the obstructed PAD seems to have expanded the PAD with resultant extrinsic compression of mid CBD Fig.


Endoscopic manometry of the sphincter of Oddi in patients with Lemmel’s syndrome. This re-demonstrated a periampullary duodenal diverticulum with adjacent inflammatory changes.

Rarely, obstructive jaundice can develop secondary to PAD in the absence of choledocholithiasis or tumor and is termed Lemmel’s syndrome 2. Diagnosis and management of the symptomatic duodenal diverticulum: A unique case of xanthogranulomatous cholecystitis complicated by multiple liver abscesses and portal vein and hepatic artery thrombosis and occlusion.

To improve our services and products, we use “cookies” own or third parties authorized to show advertising related to client preferences through the analyses of navigation customer behavior. Interestingly, an unusual appearance to the kidneys was recorded with multiple microcystic changes in both kidneys, which is typically reported ssyndrome patients with lithium induced renal disease.

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. ERCP was performed to remove the stone. Discussion Gastrointestinal sgndrome 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. Endoscopic nasobiliary drainage tubogram obtained after decompression of the PAD demonstrates resolved extrinsic syndeome B.

Other surgical options would include diverticulectomy or bilodigestive anastomosis. Computed tomography of the abdomen showed several gallbladder stones and gallbladder wall thickening.

CT characterisation of pancreatic neoplasm: Association of periampullary diverticula with primary choledocholithiasis. She was a nursing home resident who was largely dependent in activities of daily living. Second, PAD many cause dysfunction in the sphincter of Oddi 5.


CT and MR imaging findings in seven patients.

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After removal of the enterolith within the PAD, all her symptoms resolved. Barium studies can demonstrate this condition with contrast-filled outpouchings that arise from the medial side of the descending duodenum [ 9 ].

Endoscopic retrograde cholangiopancreatographic findings of enterolith within the periampullary diverticulum PAD and its removal. This study revealed a large periampullary diverticulum with mucosal enhancement and fat stranding consistent with diverticulitis.

Lemmel Syndrome Secondary to Duodenal Diverticulitis: A Case Report

CiteScore measures average citations received per document published. On duodenoscopy, the major duodenal papilla with a normal orifice was located in the periampullary duodenal diverticulum Image 2.

Contrast-enhanced computed tomography CT of the abdomen and pelvis was obtained and revealed a large periampullary diverticulum containing a fluid level with wall thickening, mucosal enhancement, synrdome surrounding fat stranding consistent with duodenal diverticulitis.

Lemmel’s syndrome, an unusual cause of abdominal pain and jaundice by impacted intradiverticular enterolith: Llemmel diverticulum at endoscopic retrograde cholangiopancreatography, analysis of patients. Hepatogastroenterology, 53pp.

In our case, blind loop created by Billroth II anastomosis seems to have provided a static environment favoring enterolith formation within the PAD. Please review our privacy policy.